http://pharmacie.hug-ge.ch/rd/posters.htmlAuthors report no conflict of interest

Debit (%)

Error cut-off

Err

or

(%)

0 50 100 150

0.0

0.2

0.4

0.6

0.8

1.0

Dose (%)

Error cut-off

Err

or

(%)

0 50 100 150

0.0

0.2

0.4

0.6

0.8

1.0

Concentration (%)

Error cut-off

Err

or

(%)

0 50 100 150

0.0

0.2

0.4

0.6

0.8

1.0

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

=