Background and aims Transition to standardised concentrations (StdC) is advised to reduce risks with IV infusions in PICU/NICU. In our unit, infusion rate is standardised and concentration varies (VarC). We performed a simulation study to evaluate the impact of StdC on prescription, preparation and administration.
Methods Simulation of electronic prescription (10 physicians), preparation/administration (10 paediatric/8 adult intensive care nurses) of 5 drugs (midazolam, fentanyl, noradrenaline, ketamine, furosemide) for 15 fictive patients (different dosage/weight). Two-sessions study (VarC vs StdC, each 150 prescriptions/270 preparations). Issues: time (mean ± SD in seconds); precision (target deviation in%, mediane [IQR]) of drug concentration (quantitative analysis), dose and rate (calculated by nurses).
Results With StdC, prescription time was significantly longer (72 ± 36 vs 86 ± 32, p < 0.001) and preparation/administration time shorter (286 ± 98 vs 216 ± 93, p < 0.0001). Precision of drug concentration was increased (4.4% [2.0 to 11.5] vs 4.1% [1.6 to 8.4], p = 0.004) with a reduction of concentrations >20% (44/270 (16.3%) vs 23/270 (8.5%), p = 0.005). Precision of dose was decreased 4.4% [2.0 to 11.1] vs 11.8% [5.1 to 23.3], p < 0.0001) with an increase of dose >20% (42/270 (15.6%) vs 83/270 (30.7%), p < 0.0001). Precision of rate was decreased (0.0% [0 to 0] vs 6.8% [3.2 to 20.6], p < 0.0001). No association with age, years of experience, number of worked hours before study, paediatric or adult ICU nurses was observed on precision.
Conclusions Preparation time and drug concentration precision was strongly improved with StdC. Strategies to deal with prescription time and poor dose and rate precision should be considered before moving to StdC.