Pharmacy Department, Royal Liverpool University Hospital, Prescot Street, Liverpool, L7 8XP, UK.
Palliative Care Institute Liverpool, University of Liverpool, Liverpool, UK.
BMC Palliat Care. 2020 Jul 7;19(1):99. doi: 10.1186/s12904-020-00611-3.
Continuous subcutaneous infusions (CSCIs) are commonly used in the United Kingdom as a way of administering medication to patients requiring symptom control when the oral route is compromised. These infusions are typically administered over 24 h due to currently available safety data. The ability to deliver prescribed medication by CSCI over 48 h may have numerous benefits in both patient care and health service resource utilisation. This service evaluation aims to identify the frequency at which CSCI prescriptions are altered at NHS Acute Hospitals.
Pharmacists or members of palliative care teams at seven acute NHS hospitals recorded anonymised prescription data relating to the drug combination(s), doses, diluent and compatibility of CSCIs containing two or more drugs on a daily basis for a minimum of 2 days, to a maximum of 7 days.
A total of 1301 prescriptions from 288 patients were recorded across the seven sites, yielding 584 discrete drug combinations. Of the 584 combinations, 91% (n = 533) included an opioid. The 10 most-common CSCI drug combinations represented 37% of the combinations recorded. Median duration of an unchanged CSCI prescription across all sites was 2 days.
Data suggests medication delivered by CSCI over 48 h may be a viable option. Before a clinical feasibility study can be undertaken, a pharmacoeconomic assessment and robust chemical and microbiological stability data will be required, as will the assessment of the perceptions from clinical staff, patients and their families on the acceptability of such a change in practice.
在英国，连续皮下输注（CSCI）常用于通过胃肠道途径给药受到限制的患者，以控制症状。由于目前可用的安全性数据，这些输注通常在 24 小时内完成。通过 CSCI 给药 48 小时以上可能在患者护理和卫生服务资源利用方面具有许多益处。本服务评估旨在确定 NHS 急症医院更改 CSCI 处方的频率。
七家 NHS 急症医院的药剂师或姑息治疗团队成员每天记录含有两种或两种以上药物的 CSCI 的药物组合、剂量、稀释剂和相容性的匿名处方数据，至少记录 2 天，最多记录 7 天。
在七个地点共记录了 288 名患者的 1301 张处方，产生了 584 种不同的药物组合。在 584 种组合中，91%（n=533）包含阿片类药物。记录的 10 种最常见的 CSCI 药物组合占记录组合的 37%。所有地点未更改的 CSCI 处方的中位数持续时间为 2 天。
数据表明，48 小时以上的 CSCI 给药可能是一种可行的选择。在进行临床可行性研究之前，需要进行药物经济学评估和稳健的化学和微生物稳定性数据，还需要评估临床工作人员、患者及其家属对这种实践改变的可接受性的看法。
