Accuracy of intravenous and enteral preparations involving small volumes for paediatric use: a review

Ainscough, L P; Ford, James L.; Morecroft, C; Peak, Matthew; Turner, Mark A.; Nunn, Anthony J; Roberts, Matthew

doi:10.1136/ejhpharm-2016-001117

Cited by 20 publications

(18 citation statements)

References 67 publications

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“…It is not known whether healthcare providers with greater experience might produce lesser errors, nor whether there might be differences in errors produced between doctors and nurses in the preparation and administration of drugs (although it is unlikely that there would be a major difference between nurses and doctors based on the results of previous research, however) 6. More work is required to determine how best to prepare and administer medications to children during resuscitation situations, especially when small volumes are required, and how best to train healthcare providers to perform these tasks 12. Given the magnitude of the potential errors, it could be useful to include instruction on—and assessment of—medication preparation and administration as part of simulation training in paediatric emergencies, including in paediatric advanced life support courses.…”

Section: Discussionmentioning

confidence: 99%

Drug preparation and administration errors during simulated paediatric resuscitations

2018

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IntroductionVery few studies have assessed drug preparation and administration errors during paediatric resuscitation. Current evidence suggests that medication errors in paediatrics are a serious problem. The aim of this study was to evaluate drug preparation and administration errors incurred during the simulated resuscitation of paediatric patients.MethodsThis was a prospective observational study performed in the emergency department of a tertiary-level hospital. Teams consisting of two emergency doctors were tasked with preparing and delivering medication during simulated emergency scenarios. Preparation processes were video recorded. All phials, syringes and administered volumes were collected and analysed to determine the accuracy of drug preparation and delivery. Deviations from intended volumes were calculated.Main resultsA total of 96 dosages were recorded from 24 participants. Most errors were identified in the withdrawal of drug phase (prior to dilution) (13 of 96 doses had a >20% error), and the administration of medication phase (20 of 96 doses had a >20% error). Overall the median time taken to deliver each drug was 79 s (IQR 59, 100 s). The largest percentage errors were seen when a large syringe was used to withdraw or administer a small volume of medication.ConclusionThe study clearly demonstrated that there were significant errors in the preparation and administration of medication. Training in the preparation and administration of paediatric medications should be available for all emergency nurses and doctors. Correct syringe choice may reduce these errors—smaller syringes should be used for withdrawing or administering smaller volumes.

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Section: Discussionmentioning

confidence: 99%

Drug preparation and administration errors during simulated paediatric resuscitations

2018

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“…The importance of accurate dosing to the youngest children has previously been highlighted [39]. Dosing devices for this age group mainly involves the use of an oral syringe or dropper though both have significant issues in terms of accuracy [40,41].…”

Section: Formulation Considerationsmentioning

confidence: 99%

“…Measuring small volumes (e.g., bolus IV injections, oral liquids, low rate IV infusions) with sufficient accuracy can be problematic if routinely available administration devices such as oral/enteral syringes and injection syringes are to be used [40]. Using a liquid product with a concentration designed to administer standard volumes to adults or older children may mean that volumes of 0.1 mL or less might be required for neonates [39,40,135,136,137,138,139]. This issue can be even more acute if clinical practice standardises on a single oral/enteral syringe design rather than using any specific device that may be provided by the manufacturer.…”

Section: Formulation Considerationsmentioning

confidence: 99%

Making Medicines Baby Size: The Challenges in Bridging the Formulation Gap in Neonatal Medicine

O’Brien

Clapham²,

Krysiak

et al. 2019

IJMS

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The development of age-appropriate formulations should focus on dosage forms that can deliver variable yet accurate doses that are safe and acceptable to the child, are matched to his/her development and ability, and avoid medication errors. However, in the past decade, the medication needs of neonates have largely been neglected. The aim of this review is to expand on what differentiates the needs of preterm and term neonates from those of the older paediatric subsets, in terms of environment of care, ability to measure and administer the dose (from the perspective of the patient and carer, the routes of administration, the device and the product), neonatal biopharmaceutics and regulatory challenges. This review offers insight into those challenges posed by the formulation of medicinal products for neonatal patients in order to support the development of clinically relevant products.

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Section: Introductionmentioning

confidence: 99%

“…Medicines marketed for IV therapy frequently need to be reconstituted and/or diluted before administration, especially in the field of pediatrics because the drug amount in the vial is adapted for adults. 1 It has already been described that reconstitution and dilution steps may lead to medication errors with i.v. drugs 2 and can endanger patients' safety or therapy effectiveness.…”

Section: Introductionmentioning

confidence: 99%

Quality control and stability of ketamine, remifentanil, and sufentanil syringes in a pediatric operating theater

Bourdon¹,

Simon

Lannoy

et al. 2019

Pediatric Anesthesia

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Summary Background Transforming a drug from its commercial form into a ready‐to‐use drug is common practice, especially in pediatrics. However, the risk of compounding error is real and data on drug stability in practice are not always available. Aims The aim of this study was to assess, in real conditions, both the error rate and stability of three drugs: ketamine, remifentanil, and sufentanil. Methods A new rapid and easy‐to‐use high‐performance liquid chromatography method with a diode array detector has been developed and validated to quantify these drugs and detect their degradation products. Over a 1‐month period, 151 syringes were collected in the postanesthesia care unit. Seventy‐three were stock solution syringes containing a 10‐fold dilution of commercial drugs and 78 were serial dilution syringes made from successive dilutions of stock solutions. A comparison between real and expected concentrations as well as the detection of possible degradation products was carried out on these samples. Results All stock solution syringes had good chemical stability throughout the working day. A 4‐µg/mL remifentanil serial dilution syringe, however, had to be discarded as a degradation peak was detected. Overall, 15.3% (95% CI, 9.5‐21.1%) of syringes had a drug concentration outside the ±10% acceptability range, that is, 11.0% (95% CI, 3.7‐18.2%) and 19.5% (95% CI, 10.6%‐28.4%) of stock and diluted syringes respectively, with drug amounts ranging from −25.3% to 22.0%. The highest error rates were observed with sufentanil syringes: 20% and 28% for stock solution and serial dilution, respectively. Conclusion The study shows that stock solution syringes prepared in advance are chemically stable throughout the day, unlike certain serial dilution syringes, indicating that the latter should be prepared just before administration to ensure chemical stability. Our results show that the error rate for serial dilution syringes is twice that of stock solution. Different safety measures are under discussion and have to be further studied.

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Accuracy of intravenous and enteral preparations involving small volumes for paediatric use: a review

Cited by 20 publications

References 67 publications

Drug preparation and administration errors during simulated paediatric resuscitations

Drug preparation and administration errors during simulated paediatric resuscitations

Making Medicines Baby Size: The Challenges in Bridging the Formulation Gap in Neonatal Medicine

Quality control and stability of ketamine, remifentanil, and sufentanil syringes in a pediatric operating theater

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