What is impact of weight-based dosing of intravenous infusion on patient safety in paediatric intensive care unit at Royal London hospital?

Abstract

1. Abstract 1.1. Background: Despite evidence for the safety and accuracy of the standard concentration approach (SCI) for intravenous infusion, most paediatric intensive care units (PICUs) in the United Kingdom, including the PICU at Royal London Hospital, continue to use the traditional weight-based approach (WBA), increasing the risk of errors. 1.2. Methodology: This project aimed to investigate the WBA and to explore the extent to which patient safety can be harmed as a consequence of its use. It was designed as a retrospective and prospective cohort study. A secondary analysis was done for medication errors gathered retrospectively from 1 September 2012 to 30 May 2022. Additionally, nine nurses (ten preparations) were observed during preparations of a group of high-alert medications. 1.3. Results: A total of 378 errors were identified during the study period, and sixteen errors were related to WBA, including four types of errors. Calculation and wrong setting of pumps were the highest (n=5; 31.3%), followed by preparation errors involving inaccuracy of withdrawn volume (25%). Interestingly, (n = 12; 75%) of the discovered errors were related to administration of high-alert medications. However, the percentage of harm was limited to 13%. Variation in preparation was noticed, and adherence of nurses to preparation techniques was only 65%. 1.4. Conclusion: Risk of medication errors can be raised by using WBA, and nature of errors results in catastrophic changes, such as ten-fold higher or lower than prescribed concentration, which leads to undesirable consequences. SCI can be a solution and it should be explored.