Standardised concentrations of morphine infusions for nurse/patient-controlled analgesia use in children

Area of Science:

• Pediatric Anesthesiology
• Pain Management
• Pharmaceutical Sciences

Background:

• Standardizing intravenous infusion concentrations enhances patient safety by minimizing deviations from prescribed doses.
• Pre-prepared, standardized morphine infusions for pediatric nurse/patient-controlled analgesia (N/PCA) have not been previously evaluated.
• This study aimed to establish, implement, and assess standardized morphine concentrations in pre-filled syringes (PFS) for pediatric N/PCA.

Purpose of the Study:

• To develop and implement standardized morphine concentrations in PFS for pediatric N/PCA.
• To evaluate the safety, efficiency, and feasibility of this standardized system.
• To compare the new system with previous methods of infusion preparation.

Main Methods:

• Morphine concentrations were determined for PFS to accommodate pediatric weight variations (1-50 kg).
• Implementation involved direct observation, focus groups, failure mode and effects analysis, surveys, and analysis of medication incident reports.
• Mixed methods were employed to evaluate the use of PFS by healthcare professionals (HCPs).

Main Results:

• Standardized concentrations (3 mg, 10 mg, 50 mg in 50 mL) were used with smart pumps for continuous and bolus doses.
• 175 infusions were administered to 157 children, with setup time reduced by one-third (3.7 ± 1.7 min).
• Medication incidents decreased by 41.2%, preparation errors were eliminated, and HCPs found the system easier and safer.

Conclusions:

• A system utilizing pre-prepared, standardized morphine concentrations for pediatric N/PCA was successfully and sustainably implemented.
• The standardized approach significantly improved patient safety and healthcare professional workflow.
• This method offers a viable solution for enhancing pediatric pain management delivery.