School of Cancer & Pharmaceutical Sciences, King's College London, 150 Stamford Street, London, SE1 9NH, UK.
Pharmacy Department, Evelina London Children's Hospital, Guy's & St Thomas' NHS Foundation Trust, Westminster Bridge Road, London, SE1 7EH, UK.
BMC Anesthesiol. 2019 Feb 23;19(1):26. doi: 10.1186/s12871-019-0697-7.
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.
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.
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.
A system using pre-prepared standardized concentrations of morphine for paediatric N/PCA was implemented successfully and sustainably.
标准化静脉输液浓度可实现预配制，通过避免病房和手术室个别配制时可能出现的与规定浓度的较大偏差，有效提高患者安全性。预先配制的标准化吗啡浓度输液在儿科护士/患者自控镇痛（N/PCA）中尚未得到研究。我们旨在建立、实施和评估用于儿科 N/PCA 的预填充注射器（PFS）中吗啡的标准化浓度。
确定适合 1-50kg 体重范围剂量变化的 PFS 中吗啡的浓度。使用 PFS 输注通过混合方法实施和评估，包括直接观察医护人员（HCP）、焦点小组和失效模式与影响分析、HCP 调查和药物事件报告分析。
标准化浓度为 3mg、10mg 和 50mg 吗啡的 50mL 氯化钠 0.9%，使用可编程智能输液泵以可变输液率输送规定的持续和推注剂量。在实施过程中，175 次吗啡预配制输液用于手术室和病房的 157 名儿童（9.4±5.1 岁）。设置 N/PCA 所需的时间为 3.7±1.7 分钟，与之前的系统相比减少了三分之一。与 N/PCA 输液相关的事件数量减少了 41.2%，且消除了配制错误。HCP 报告使用吗啡 PFS 是一种更简单、更安全的系统。
成功且可持续地实施了一种用于儿科 N/PCA 的预配制标准化吗啡浓度系统。
