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http://pharmacie.hug-ge.ch/rd/posters.htmlAuthors report no conflict of interest
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STDVAR
Impact of standardized concentrations on drug infusion process
in PICU/NICU: a simulation study from prescription to administration
Senhaji S1,3, Luhmann-Lunt C2, Corbelli R2, Combescure C3, Rimensberger P2, Fonzo-Christe C1, Bonnabry P1,3
1Pharmacy, 2Neonatal and Pediatric Intensive Care, 3Clinical Research Center and Division of Clinical Epidemiology, Geneva University Hospitals (HUG), Geneva, Switzerland3School of pharmaceutical sciences, University of Geneva, University of Lausanne, Geneva, Switzerland
Background
Methods
1. Standardizing the
infusion rate by varying the
drug concentration (VarC)
To perform a SIMULATION STUDY to assess the impact of standard concentration (StdC)
on IV drug prescription, preparation and administrationAims
PICU NICU
HIGH
RISK PROCESS
Ref.: 1. Jt Comm Perspect 2004;24:11 / 2. Hospital Pharmacy 1994;29:939
Conclusion
StdC are advised in the
USA to reduce risks of
preparation errors.1
Intravenous (IV)
drug infusions 2 methods for preparation/administration are common :
In our PICU/NICU, IV-
infusions prepared in VarC
2. Standardizing the drug
concentration (StdC) and
varying the infusion rate
5 drugs•midazolam
•fentanyl
•noradrenaline
•ketamine
•furosemide
for 15 fictive
patients
(different dosage
/weight)
PrecisionAnalysis #1: deviation from target in %,
mediane [IQR25-75])
Analysis #2: deviation of more than 20%
from target (>±20%) of :
Drug concentration (DC) (quantitative analysis),
Dose (extrapol from DC and rate calculation),
Rate (calculated by nurses)
2 experiences Fictive cases
Two-sessions study
VarC vs StdC
Design
150 prescriptions / 270
preparations (each session)
Issues
Results
No association with age, years of experience, number of worked hours
before study, pediatric or adult ICU nurses was observed on precision.
Preparation time and drug
concentration precision was
strongly improved with StdC.
Strategies to deal with the
longer prescription time and
poor dose and rate precision
should be considered before
moving to StdC.
Drug concentration (DC) Dose (DC x Rate) Rate calculation
VarC
Std
C
20% 20% 20%Deviation from the target(%)
Analysis #1 : Concentration deviation
4.4% [2.0 to 11.5] vs 4.1% [1.6 to 8.4]
p=0.004
Analysis #2 : Concentration>±20%
44/270 (16.3%) vs 23/270 (8.5%)
p=0.005
Pro
port
ion
measure
s
Analysis #1 : Dose deviation
4.4% [2.0 to 11.1] vs 11.8% [5.1 to 23.3]
p<0.0001
Analysis #2 : Dose >±20%
42/270 (15.6%) vs 83/270 (30.7%)
p<0.0001
Analysis #1 : Targeted deviation
0.0% [0 to 0] vs 6.8% [3.2 to 20.6]
p<0.0001
Analysis #2 : Rate >±20%
26/270 (9.6%) vs 80/270 (29.6%)
p<0.0001
For StdC when compared to VarC
the drug concentration was more precise
with a significant reduction (almost by
50%) in the number of samples with a
measured deviation of more than 20%.
But the precision of the
delivered dose was less
precise with a significant
increase (almost by twice) in
the number of values with
more than 20% above target.
These results can be mainly
explained by calculation
errors and flowrate rounding.
prepared with
the rule of six2
(adapted to the
body weight and
infusion rate)
3 dilutions
(low, medium,
high) per drug
Global Preparation time
was shorter due to a
strong reduction of
preparation time
Move to?
Time (mean±SD in sec.)
Deviation from the target(%) Deviation from the target(%)
Pro
port
ion m
easure
s
Pro
port
ion m
easure
s
1. Electronic
prescription
10 physicians
2. Preparation
& Administration
10 PICU / 8 ICU
nurses
=