Projects per year
Abstract
Objective: To develop evidence-based proposals for the intravenous drug compatibility information provided by the NHS Injectable Medicines Guide (“Medusa”).
Method: An online survey and a Delphi study were used to compare the opinions of Medusa users and subject experts. All Medusa users were eligible to complete the online survey, which was advertised via the Medusa homepage and professional networks. It asked participants to rate the importance of 13 types of compatibility information (identified from the literature) and their agreement with five statements about their experience of the current Medusa compatibility section.
A panel of NHS nurses and pharmacists with varied but relevant expertise in the compatibility of intravenous medicines took part in three rounds of a Delphi study (1). Based on the literature, 36 statements relating to all the possible information that might be included in the Medusa compatibility section were developed. For each Delphi round, an online survey asked participants to rate their agreement with each statement on a six-point Likert scale and give a free-text explanation. Consensus was defined as a median score of ≥5 (=’agree’) with an interquartile range <1.75 for both professions (1). When consensus was achieved for a particular statement, it was removed from subsequent rounds. The remaining statements were presented again, but with a summary of responses from the previous round.
The project was reviewed and approved as a service evaluation by Imperial College Healthcare NHS Trust.
Results: 142 Medusa users completed the survey (114 nurses, 28 pharmacists). >50% of participants reported administering IV fluids, antibiotics, analgesics, insulin and electrolytes via the same intravenous line or lumen as another drug over the previous year. Participants rated information on whether drugs are compatible or incompatible, and the concentrations and diluents in which this occurs, to be most important (Friedman test p<0.001, Dunn-Bonferroni post hoc tests ≤0.028). There was a median rating of ‘agree’ for all five user experience statements, suggesting most participants find the current compatibility information useful, relevant and easy to find, understand and use.
41 experts participated in at least one round of the Delphi study (16 nurses, 25 pharmacists). After three rounds, there was consensus that: 1) compatibility and incompatibility information should be provided for medicines given by continuous or short infusion; 2) this should be based on laboratory data and reports of visual incompatibility; 3) this should include information on compatible concentrations, diluents and the length of time medicines are compatible.
Discussion: The current Medusa compatibility section is meeting the needs of most users. However, users and experts suggest that compatibility information should be provided for all medicines and include compatible concentrations and diluents. This is in tension with NPSA Alert 20, which recommended providing information for commonly used mixtures in specialist areas only (2).
Conclusion: The Medusa Advisory Board should decide whether Medusa is a quick reference guide for common drug combinations, or a comprehensive source of compatibility information. This will enable appropriate decisions to improve its usability of even further. This decision should be clearly communicated to users.
References:
1. Trevelyan EG, Robinson PN. Delphi methodology in health research: how to do it? Eur J Integr Med. 2015;7(4):423-8.
2. National Patient Safety Agency. Patient safety alert 20: Promoting safer use of injectable medicines. 2007.
Method: An online survey and a Delphi study were used to compare the opinions of Medusa users and subject experts. All Medusa users were eligible to complete the online survey, which was advertised via the Medusa homepage and professional networks. It asked participants to rate the importance of 13 types of compatibility information (identified from the literature) and their agreement with five statements about their experience of the current Medusa compatibility section.
A panel of NHS nurses and pharmacists with varied but relevant expertise in the compatibility of intravenous medicines took part in three rounds of a Delphi study (1). Based on the literature, 36 statements relating to all the possible information that might be included in the Medusa compatibility section were developed. For each Delphi round, an online survey asked participants to rate their agreement with each statement on a six-point Likert scale and give a free-text explanation. Consensus was defined as a median score of ≥5 (=’agree’) with an interquartile range <1.75 for both professions (1). When consensus was achieved for a particular statement, it was removed from subsequent rounds. The remaining statements were presented again, but with a summary of responses from the previous round.
The project was reviewed and approved as a service evaluation by Imperial College Healthcare NHS Trust.
Results: 142 Medusa users completed the survey (114 nurses, 28 pharmacists). >50% of participants reported administering IV fluids, antibiotics, analgesics, insulin and electrolytes via the same intravenous line or lumen as another drug over the previous year. Participants rated information on whether drugs are compatible or incompatible, and the concentrations and diluents in which this occurs, to be most important (Friedman test p<0.001, Dunn-Bonferroni post hoc tests ≤0.028). There was a median rating of ‘agree’ for all five user experience statements, suggesting most participants find the current compatibility information useful, relevant and easy to find, understand and use.
41 experts participated in at least one round of the Delphi study (16 nurses, 25 pharmacists). After three rounds, there was consensus that: 1) compatibility and incompatibility information should be provided for medicines given by continuous or short infusion; 2) this should be based on laboratory data and reports of visual incompatibility; 3) this should include information on compatible concentrations, diluents and the length of time medicines are compatible.
Discussion: The current Medusa compatibility section is meeting the needs of most users. However, users and experts suggest that compatibility information should be provided for all medicines and include compatible concentrations and diluents. This is in tension with NPSA Alert 20, which recommended providing information for commonly used mixtures in specialist areas only (2).
Conclusion: The Medusa Advisory Board should decide whether Medusa is a quick reference guide for common drug combinations, or a comprehensive source of compatibility information. This will enable appropriate decisions to improve its usability of even further. This decision should be clearly communicated to users.
References:
1. Trevelyan EG, Robinson PN. Delphi methodology in health research: how to do it? Eur J Integr Med. 2015;7(4):423-8.
2. National Patient Safety Agency. Patient safety alert 20: Promoting safer use of injectable medicines. 2007.
Original language | English |
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Publication status | Published - 6 Jun 2024 |
Event | National Infusions and Vascular Access Society Conference - Manchester Deansgate Hotel, Manchester, UK United Kingdom Duration: 6 Jun 2024 → 7 Jun 2024 https://nivas.org.uk/conference/12th-nivas-conference-2024 |
Conference
Conference | National Infusions and Vascular Access Society Conference |
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Country/Territory | UK United Kingdom |
City | Manchester |
Period | 6/06/24 → 7/06/24 |
Internet address |
Keywords
- Intravenous
- compatibility
- Delphi study
- Delphi method
- Delphi survey
- Delphi technique
- guidelines
- Guidelines as Topic
- information needs
- nurses
- pharmacists
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- 1 Finished
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Academic secondment to NHS Injectable Medicines Guide
Jones, M. (PI)
1/02/23 → 31/07/23
Project: Central government, health and local authorities