Incidence and Causes of Infusion Alarms in a Neonatal and Pediatric Intensive Care Unit: A Prospective Pilot Study

Fonzo-Christe, Caroline; Bochaton, Nathalie; Kiener, A; Rimensberger, Peter C.; Bonnabry, Pascal

doi:10.5863/1551-6776-25.6.500

Cited by 10 publications

(11 citation statements)

References 29 publications

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“…There is no known evidence of direct patient harm from a change in absorbance of active ingredients or adjuvants. However, particles or turbidity can have serious adverse drug reactions in children and particularly in neonates [1][2][3] and therefore concurrent administration should be avoided. Furthermore, in clinical settings not only incompatibilities but also the knowledge of compatibilities is important for a safe infusion therapy.…”

Section: Discussionmentioning

confidence: 99%

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Y‐site administration of electrolyte solutions and injectable acetaminophen—A physical compatibility study with combinations frequently used in pediatric intensive care and anesthesia

Kleinlein¹,

Marschler²,

Neininger

et al. 2022

Pediatric Anesthesia

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Aim Determination of the physical compatibility of acetaminophen and two different electrolyte solutions (an isotonic, balanced electrolyte solution and a hypotonic, glucose containing electrolyte solution) with drugs frequently used in routine pediatric intensive care. Methods Analytical investigations for frequently used combinations without pre‐existing data were performed. Visual and microscopic observations according to the European Pharmacopeia as well as pH measurements and ultraviolet visible spectrometry at wavelengths of 350, 410 and 550 nm were conducted to analyze physical compatibility. All measurements were performed immediately after mixing as well as 1, 4, and 24 h after. Results In total, 42 combinations were analyzed. Visual incompatibilities were found with pantoprazole and diazepam with both electrolyte solutions. For furosemide, a particle formation in mixture with the hypotonic glucose‐containing electrolyte solution and a change in pH ≥ 0.5 after 24 h with both electrolyte solutions were observed. Ampicillin, cefuroxime, diazepam, furosemide, linezolid, meropenem, and pantoprazole showed an aberration of the absorbance ≥0.04 (350 nm/410 nm) or ≥0.01 (550 nm) in the photometric measurements with the electrolyte solutions. For acetaminophen, a physical incompatibility was observed with ampicillin, diazepam, furosemide, and pantoprazole. Conclusion Most of the analyzed combinations showed no signs of physical incompatibility and may therefore be administered via the same Y‐site. However, diazepam, furosemide, and pantoprazole should not be administered simultaneously with acetaminophen or both electrolyte solutions.

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Section: Discussionmentioning

confidence: 99%

“…1 This can cause complications such as catheter occlusion, blood-vessel irritation, or embolism. 2,3 Chemical reactions can lead to a degradation of the drugs and are considered as significant when more than 10% degradation occurs. 1 As a result, a reduced effectiveness can be seen in patients.…”

Section: Introductionmentioning

confidence: 99%

Y‐site administration of electrolyte solutions and injectable acetaminophen—A physical compatibility study with combinations frequently used in pediatric intensive care and anesthesia

Kleinlein¹,

Marschler²,

Neininger

et al. 2022

Pediatric Anesthesia

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“…Another study found that due to line occlusions, drug incompatibilities, and patient factors, alarms from infusion pumps were frequent in the NICU/pediatric ICU. 53 This also implies that more training or special coordination is required of nursing staff in those units with respect to infusion administration.…”

Section: Discussionmentioning

confidence: 99%

Quantifying the Impact of Infusion Alerts and Alarms on Nursing Workflows: A Retrospective Analysis

Obuseh

DeLaurentis

2021

Appl Clin Inform

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Background Smart infusion pumps affect workflows as they add alerts and alarms in an information-rich clinical environment where alarm fatigue is already a major concern. An analytic approach is needed to quantify the impact of these alerts and alarms on nursing workflows and patient safety. Objectives To analyze a detailed infusion dataset from a smart infusion pump system and identify contributing factors for infusion programming alerts, operational alarms, and alarm resolution times. Methods We analyzed detailed infusion pump data across four hospitals in a health system for up to 1 year. The prevalence of alerts and alarms was grouped by infusion type and a selected list of 32 high-alert medications (HAMs). Logistic regression was used to explore the relationship between a set of risk factors and the occurrence of alerts and alarms. We used nonparametric tests to explore the relationship between alarm resolution times and a subset of predictor variables. Results The study dataset included 745,641 unique infusions with a total of 3,231,300 infusion events. Overall, 28.7% of all unique infusions had at least one operational alarm, and 2.1% of all unique infusions had at least one programming alert. Alarms averaged two per infusion, whereas at least one alert happened in every 48 unique infusions. Eight percent of alarms took over 4 minutes to resolve. Intravenous fluid infusions had the highest rate of error-state occurrence. HAMs had 1.64 more odds for alerts than the rest of the infusions. On average, HAMs had a higher alert rate than maintenance fluids. Conclusion Infusion pump alerts and alarms impact clinical care, as alerts and alarms by design interrupt clinical workflow. Our study showcases how hospital system leadership teams can leverage infusion pump informatics to prioritize quality improvement and patient safety initiatives pertaining to infusion practices.

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“…Within critical care, and particularly in pediatric and neonatal critical care, evidence is beginning to emerge that incompatibility between medications can cause the precipitation of medications in the venous access device [ 1 ], which may result in intravenous access failure or partial occlusion of peripheral access devices and central lines. A recent study [ 2 ] showed that venous access occlusion alarms are responsible for 55% of all intravenous infusion pump alarms in neonatal intensive care units and that noninfusion of critical short–half-life infusions (due to such occlusions) has the potential to cause severe cardiovascular instability in critical care patients receiving vasoactive medications.…”

Section: Introductionmentioning

confidence: 99%

“…The problem of limited access and multiple infusions running into a single venous access device is common in critical care, particularly in pediatric and neonatal critical care settings. Fonzo-Christe et al [ 1 ] suggested that the filtration of medications might be one method of reducing the risk of precipitation during multiple concurrent infusions; however, the questions—for which medications? and how can we ensure that nursing staff are aware of and able to comply with such requirements?—should be asked.…”

Section: Introductionmentioning

confidence: 99%

Critical Care Nurses’ Knowledge of Correct Line Types for Administration of Common Intravenous Medications: Assessment and Intervention Study

Al-Jaber¹,

Samuda²,

Chaker³

et al. 2022

JMIR Form Res

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Background There is a paucity of information in the literature on core nursing staff knowledge on the requirements of specific intravenous administration lines for medications regularly given in critical care. There is also a lack of well-researched and appropriate information in the literature for intravenous administration line selection, and the need for filtration, protection from light, and other line-material selection precautions for many critical and noncritical medications used in these settings to maintain their potency and efficacy. Objective We aimed to assess the knowledge gap of clinicians with respect to intravenous administration line set material requirements for critical care medications. Methods Data were drawn from a clinician knowledge questionnaire, a region-wide database of administered infusions, and regional data on standard and special intravenous administration line consumption for 1 year (2019-2020) from an enterprise resource planning system log. The clinician knowledge questionnaire was validated with 3 groups (n=35) and then released for a general survey of critical care nurses (n=72) by assessing response dispersal and interrater reliability (Cronbach α=.889). Correct answers were determined by referencing available literature, with consensus between the team’s pharmacists. Percentage deviations from correct answers (which had multiple possible selections) were calculated for control and test groups. We reviewed all 3 sources of information to identify the gap between required usage and real usage, and the impact of knowledge deficits on this disparity. Results Percentage deviations from correct answers were substantial in the control groups and extensive in the test group for all medications tested (percentage deviation range –43% to 93%), with the exception of for total parenteral nutrition. Respondents scored poorly on questions about medications requiring light protection, and there was a difference of 2.75% between actual consumption of lines and expected consumption based on medication type requirement. Confusion over the requirements for low-sorbing lines, light protection of infusions, and the requirement for filtration of specific solutions was evident in all evidence sources. The consumption of low-sorbing lines (125,090/1,454,440, 8.60%) was larger than the regional data of medication usage data would suggest as being appropriate (15,063/592,392, 2.54%). Conclusions There is no single source of truth for clinicians on the interactions of critical care intravenous medications and administration line materials, protection from light, and filtration. Nursing staff showed limited knowledge of these requirements. To reduce clinical variability in this area, it is desirable to have succinct easy-to-access information available for clinicians to make decisions on which administration line type to use for each medication. The study’s results will be used to formulate solutions for bedside delivery of accurate information on special intravenous line requirements for critical care medications.

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Incidence and Causes of Infusion Alarms in a Neonatal and Pediatric Intensive Care Unit: A Prospective Pilot Study

Cited by 10 publications

References 29 publications

Y‐site administration of electrolyte solutions and injectable acetaminophen—A physical compatibility study with combinations frequently used in pediatric intensive care and anesthesia

Y‐site administration of electrolyte solutions and injectable acetaminophen—A physical compatibility study with combinations frequently used in pediatric intensive care and anesthesia

Quantifying the Impact of Infusion Alerts and Alarms on Nursing Workflows: A Retrospective Analysis

Critical Care Nurses’ Knowledge of Correct Line Types for Administration of Common Intravenous Medications: Assessment and Intervention Study

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