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The development of a paediatric specific online injectable medicines guide. Stage one: an assessment of paediatric nurses' current practice
  1. R Lilley1,
  2. S Collins2,
  3. P North-Lewis1
  1. 1St James's Hospital, Leeds Teaching Hospitals NHS Trust (LTHT), Leeds, UK
  2. 2Leeds General Infirmary, Leeds, UK

Abstract

The National Patient Safety Agency (NPSA) set out recommendations for the availability of technical information for the preparation and administration of injectable medicines in 2007.1 Specifically the NPSA state that information regarding (1) Product reconstitution, (2) Final solution concentration, (3) Example calculations, (4) Appropriate diluents and flushes, (5) Drug stability, (6) Rate of administration, (7) Drug–drug and drug–fluid compatibility, (8) Specialist handling information and (9) Specialist technical information should be available at the point of administration. This survey was undertaken to establish which sources of information paediatric nurses use when preparing or administering drugs and their level of satisfaction with them. This is part of an overall service development to improve the safety of injectable drugs for paediatric patients.

Methods 90 questionnaires were distributed to nurses in 18 paediatric areas over two sites. The questionnaires, containing seven questions, were designed to assess the opinions of staff administering injectable drugs.

Results 86% questionnaires were completed; respondents represented a range of nurses (58% band 5, 26% band 6, 17% band 7). On the whole respondents were satisfied with the standard of technical information they currently utilised: median satisfaction score was 7 out 10 (where 1 was very dissatisfied and 10 was very satisfied). However, the majority of responders believed that they did not have access to information from four out the nine categories suggested by the NPSA: information regarding appropriate diluents and flushes, drug–drug and drug–fluid compatibility, specialist handling information and specialist technical information was considered lacking. For example, 61% believed that information regarding reconstitution was supplied for most injectable medicines, 68% believed that they did not have access to specialised technical information (eg, displacement values) for the majority of the injectable drugs they administered.

74% of nurses use at least three resources to find technical information, less than 7% of those questioned use only one reference source. The most commonly utilised were the BNFC (90%), product information leaflet supplied with the drug (83%) and ward based literature (posters, files, etc) (81%). Ward-based guides were often out of date, with some not updated since 1997 (median 2006, range 1997–2009). Although it is available throughout LTHT only 21% used the online Injectable Medicines Guide (Medusa) as it was not thought to be presented in an easy to use format.

Conclusions Although the majority of paediatric nurses surveyed appeared satisfied with the quantity of information available regarding paediatric injectable drugs, further questioning showed a lack of accessibility of technical data at ward level. In general responder's used information that was easily available to them, most commonly the BNFC despite it not providing the detail of information required. In order to change practice and encourage utilisation of the new on-line resource we are developing, computer access at the point of administration and in drug rooms may be required.

This survey has highlighted the need for a comprehensive single resource for nurses to use at ward level that is easy to use, maintain and update. We are now in the process of developing a paediatric specific online injectable medicines guide to meet this need.

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