SP4 NICU staff perspectives on the proposed introduction of standardised drug infusion concentrations
Authors: Hibberd Suzannah 
Published: June 2023

Background

In April 2021, the NPPG proposed standardised concentrations (SC) of IV drugs for use within the PICU environment, this was supported by the RCPCH and is beginning to be implemented nationally.1These concentrations were deemed to be suitable for all children over 2kg, therefore the neonatal population especially preterm infants need further consideration. Many United Kingdom NICUs still use weight-based dosing and therefore the concept of SC would constitute a significant change in practice which requires careful thought and preparation prior to implementation. The aim of using SC is to improve medication safety within our neonatal units as they have been shown to be safer and more efficient than the weight-based prescribing currently classed as standard practice.

Aim

To obtain the views of neonatal staff on the concept of introducing standardised drug infusion concentrations.

Method

Potential SC for NICU drug infusions were compiled and a briefing paper sent to senior neonatal staff including comparisons with current practice to illustrate what the change might mean. A semi-structured focus group was led by the neonatal pharmacists to discuss the concept of SC and conceivable problems with implementation. The focus group consisted of 11 Neonatologists, the neonatal unit matron, and six Band 7 nurses including the nurse lead for the neonatal transport service and the system manager of the clinical information systems in critical care.

Results

Discussed advantages of SC included the ease of preparation, standardisation across the neonatal network improving transfers between units, and the potential for compatibility testing with other drugs and parenteral nutrition. Concerns included the expense and storage of pre-filled syringes, and selecting the correct concentration at both prescribing and administration stages when several options are available. The consensus was that robust guidance would be required including which initial concentration to select dependent on patient weight and methods employed to reduce the chance of picking errors. Education was a dominant theme to ensure all medical and nursing staff were confident in calculating rates, they would have the electronic drug templates and smart pumps with drug libraries providing an additional check. When asked about launching SC on NICU, it was agreed that all drugs with SC switch on a specified date but acknowledged that not all drugs would have a SC on NICU and therefore a hybrid system would initially be required.

Conclusion

This work demonstrates the initial thoughts and concerns of NICU staff that need consideration whilst planning implementation of SC of IV drug infusions to encourage a smooth and safe transition in changing practice. The consensus was to launch all new standardisation concentrations at the same time to avoid confusion, ensuring that necessary staff support, and education was in place. Limitations of this work were that not all grades of staff were invited to the focus group and views were only from one tertiary NICU and it is known that practices differ between units within the region.

Reference

Neonatal and Paediatric Pharmacists Group. (2021). Standardising intravenous infusion concentrations for children in the UK. A Proposal for a National Approach. Available from: https://www.rcpch.ac.uk/sites/default/files/2021-05/Standard%20Infusions%20JMC%20Paper%20v0.2.pdf