Objectives To evaluate the utility of the Central Intravenous Additive Service (CIVAS) offered to the Paediatric Intensive Care Unit (PICU) including determining the percentage of items being ordered by nurses and the proportion of doses ordered which are administered to patients.
Method Data was collected each weekday over a 2 week period. All drug charts with drugs prescribed that could be made in CIVAS were recorded. The Electronic Patient Record system used to order CIVAS products was checked and the number of drugs ordered per patient recorded. Nurses were questioned regarding which products had been administered during that shift. Information was reconciled against numbers of CIVAS syringes remaining in the ward fridges. Data was analysed using Excel.
Results There were a total of 57 prescriptions for drugs which were suitable to be made in CIVAS. Of these potential items 63% (n=36) had been ordered. 56% (n=32) by nursing staff and 7% (n=4) by a clinical pharmacist. Of those ordered 30.5% (n=11) were administered to the patient, and a further 30.5% were available for administration over the weekend. 39% (n=14) of the drugs prepared by CIVAS were not administered leading to wastage. Reasons for not administering included drug stopping before product arrived on ward, dose changing and patient discharged. Of the incidences where a CIVAS product could have been used, but was not, over two thirds were because the prescription had been initiated after the cut off time for ordering.
Conclusion Utility of the CIVA service to PICU is limited by the fact that it is only available Monday to Friday and ordered only once a day. The current service appears to be inefficient with only two thirds of preparations made being suitable for administration. A complete review of service is therefore required to look at the financial and safety aspects. Potential solutions include increasing the service to 7 days per week, making ordering a ward round led activity or switching the staff responsibly for ordering. It would also be worth considering batch production of dose banded products or a “Decentralised” Intravenous Additive Service (DIVAS) which would potentially more responsive to ward‘s needs.