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Posted: March 3rd, 2020
Improving and Standardising the Quality of Care in the Neonatal Intensive Care Unit at KAMC: Developing and Implementing Standard Concentrations of Continuous Infusion Medication
Continuous infusion medication is a common practice in neonatal intensive care units (NICUs) to deliver drugs that require precise dosing and titration, such as analgesics, sedatives, antibiotics, inotropes, and vasopressors. However, the lack of standardisation of drug concentrations and preparation methods can increase the risk of medication errors, adverse drug events, and waste of resources. Therefore, it is essential to develop and implement standard concentrations of continuous infusion medication for neonates, based on the best available evidence and consensus among experts.
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Benefits of Standard Concentrations
Standardising concentrations of continuous infusion medication can have several benefits for the quality and safety of neonatal care, such as:
- Reducing medication error risk when critically ill neonates are transferred from one facility to another
- Allowing development of standardised infusion device drug libraries
- Supplying the demand necessary for manufacturers to offer commercially prepared products when not already available
- Reducing risk of extemporaneous compounding errors within hospitals
- Facilitating the production of a national injectables guide to provide the end user with the information necessary to safely administer such medications
- Improving efficiency and reducing waste of resources by avoiding multiple concentrations and preparation methods
Challenges and Considerations
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However, developing and implementing standard concentrations of continuous infusion medication also pose some challenges and require some considerations, such as:
- The need to accommodate the smallest patients and the multidisciplinary team caring for them
- The need to ensure measurable volumes and rates, and avoid excessive fluid from medications
- The need to avoid concentrations that are a ten-fold difference or have similar names or appearances
- The need to use concentrations of known stability and compatibility with other drugs and fluids
- The need to consider the availability and cost of commercially prepared products versus extemporaneously compounded products
- The need to educate and train staff on the changes and monitor compliance and outcomes
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Recommendations
Several organisations have published recommendations for standard concentrations of continuous infusion medication for neonates, based on literature review, expert opinion, modelling, and feedback. Some examples are:
- The Institute for Safe Medication Practices (ISMP) and Vermont Oxford Network (VON) published a list of recommended concentrations for 18 drugs commonly used in NICUs in 2011, which was updated in 2022 to reflect changes in practice and regulations
- The Intensive Care Society (ICS) published a list of recommended concentrations for 20 drugs commonly used in critical care, including neonates, in 2020, which was endorsed by several professional bodies
- The Royal College of Paediatrics and Child Health (RCPCH) published a list of recommended concentrations for 20 drugs commonly used in paediatric and neonatal care, based on a national consensus project involving multiple stakeholders
- The American Society of Health-System Pharmacists (ASHP) published a list of recommended concentrations for 15 drugs commonly used in paediatric care, including neonates, in 2017
These recommendations can serve as a starting point for developing and implementing standard concentrations of continuous infusion medication in NICUs. However, each facility should also consider its own context, resources, and needs, and involve relevant staff and stakeholders in the process. Moreover, each facility should evaluate the impact of the changes on patient outcomes, staff satisfaction, and resource utilisation.
Conclusion
Standardising concentrations of continuous infusion medication is an important strategy to improve the quality and safety of neonatal care. It can reduce medication errors, adverse drug events, waste of resources, and variability in practice. However, it also requires careful planning, implementation, education, monitoring, and evaluation. Therefore, NICUs should adopt standard concentrations based on the best available evidence and consensus among experts, while also considering their own context, resources, and needs.
References
: Neonatal Drug Concentrations – Updated November 2022. Vermont Oxford Network. URL: https://public.vtoxford.org/wp-content/uploads/2022/11/Neonatal-Drug-Concentrations-Updated-November-2022.pdf
: Standard medication concentrations. Intensive Care Society. URL: https://ics.ac.uk/resource/standard-concentrations.html
: Standard Concentration Infusions for Paediatric and Neonatal care. Royal College of Paediatrics and Child Health. URL: https://qicentral.rcpch.ac.uk/medsiq/medicines-safety/standard-concentration-infusions-for-paediatric-and-neonatal-care/
: Pediatric Continuous Infusion Standards. American Society of Health-System Pharmacists. URL: https://www.ashp.org/-/media/assets/pharmacy-practice/s4s/docs/Pediatric-Infusion-Standards.ashx
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