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Standardised concentrations of morphine infusions for nurse/patient-controlled analgesia use in children

BACKGROUND: Standardizing concentrations of intravenous infusions enables pre-preparation and is effective in improving patient safety by avoiding large deviations from the prescribed concentration that can occur when infusions are made individually in wards and theatres. The use of pre-prepared mor...

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Autores principales: Rashed, Asia N, Whittlesea, Cate, Davies, Caroline, Forbes, Ben, Tomlin, Stephen
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6387512/
https://www.ncbi.nlm.nih.gov/pubmed/30797229
http://dx.doi.org/10.1186/s12871-019-0697-7
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author Rashed, Asia N
Whittlesea, Cate
Davies, Caroline
Forbes, Ben
Tomlin, Stephen
author_facet Rashed, Asia N
Whittlesea, Cate
Davies, Caroline
Forbes, Ben
Tomlin, Stephen
author_sort Rashed, Asia N
collection PubMed
description BACKGROUND: Standardizing concentrations of intravenous infusions enables pre-preparation and is effective in improving patient safety by avoiding large deviations from the prescribed concentration that can occur when infusions are made individually in wards and theatres. The use of pre-prepared morphine standardized concentration infusions for paediatric nurse/patient-controlled analgesia (N/PCA) has not been previously investigated. We aimed to establish, implement and evaluate standardized concentrations of morphine in pre-filled syringes (PFS) for use in paediatric N/PCA. METHODS: Concentrations of morphine in PFS for N/PCA were identified that accommodated dosage variation across a 1–50 kg weight range. The use of infusions in PFS was implemented and evaluated using mixed methods involved direct observation of healthcare professionals (HCPs), focus groups and failure mode and effects analysis, a HCP survey and medication incident reports analysis. RESULTS: Standardized concentrations, 3 mg, 10 mg and 50 mg morphine in 50 mL sodium chloride 0.9%, delivered prescribed continuous and bolus doses using programmable smart pumps with variable infusion rates. During the implementation, 175 morphine pre-prepared infusions were administered to 157 children (9.4 ± 5.1 years) in theatres and wards. Time taken to set up a N/PCA was 3.7 ± 1.7 min, a reduction of one third compared with the previous system. The number of incidents associated with N/PCA infusions was reduced by 41.2%, and preparation errors were eliminated. HCPs reported using morphine PFS was an easier and safer system. CONCLUSION: A system using pre-prepared standardized concentrations of morphine for paediatric N/PCA was implemented successfully and sustainably. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1186/s12871-019-0697-7) contains supplementary material, which is available to authorized users.
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spelling pubmed-63875122019-03-04 Standardised concentrations of morphine infusions for nurse/patient-controlled analgesia use in children Rashed, Asia N Whittlesea, Cate Davies, Caroline Forbes, Ben Tomlin, Stephen BMC Anesthesiol Research Article BACKGROUND: Standardizing concentrations of intravenous infusions enables pre-preparation and is effective in improving patient safety by avoiding large deviations from the prescribed concentration that can occur when infusions are made individually in wards and theatres. The use of pre-prepared morphine standardized concentration infusions for paediatric nurse/patient-controlled analgesia (N/PCA) has not been previously investigated. We aimed to establish, implement and evaluate standardized concentrations of morphine in pre-filled syringes (PFS) for use in paediatric N/PCA. METHODS: Concentrations of morphine in PFS for N/PCA were identified that accommodated dosage variation across a 1–50 kg weight range. The use of infusions in PFS was implemented and evaluated using mixed methods involved direct observation of healthcare professionals (HCPs), focus groups and failure mode and effects analysis, a HCP survey and medication incident reports analysis. RESULTS: Standardized concentrations, 3 mg, 10 mg and 50 mg morphine in 50 mL sodium chloride 0.9%, delivered prescribed continuous and bolus doses using programmable smart pumps with variable infusion rates. During the implementation, 175 morphine pre-prepared infusions were administered to 157 children (9.4 ± 5.1 years) in theatres and wards. Time taken to set up a N/PCA was 3.7 ± 1.7 min, a reduction of one third compared with the previous system. The number of incidents associated with N/PCA infusions was reduced by 41.2%, and preparation errors were eliminated. HCPs reported using morphine PFS was an easier and safer system. CONCLUSION: A system using pre-prepared standardized concentrations of morphine for paediatric N/PCA was implemented successfully and sustainably. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1186/s12871-019-0697-7) contains supplementary material, which is available to authorized users. BioMed Central 2019-02-23 /pmc/articles/PMC6387512/ /pubmed/30797229 http://dx.doi.org/10.1186/s12871-019-0697-7 Text en © The Author(s). 2019 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research Article
Rashed, Asia N
Whittlesea, Cate
Davies, Caroline
Forbes, Ben
Tomlin, Stephen
Standardised concentrations of morphine infusions for nurse/patient-controlled analgesia use in children
title Standardised concentrations of morphine infusions for nurse/patient-controlled analgesia use in children
title_full Standardised concentrations of morphine infusions for nurse/patient-controlled analgesia use in children
title_fullStr Standardised concentrations of morphine infusions for nurse/patient-controlled analgesia use in children
title_full_unstemmed Standardised concentrations of morphine infusions for nurse/patient-controlled analgesia use in children
title_short Standardised concentrations of morphine infusions for nurse/patient-controlled analgesia use in children
title_sort standardised concentrations of morphine infusions for nurse/patient-controlled analgesia use in children
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6387512/
https://www.ncbi.nlm.nih.gov/pubmed/30797229
http://dx.doi.org/10.1186/s12871-019-0697-7
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