Related Experiment Video
Updated: Jul 11, 2025
A Novel Approach for the Administration of Medications and Fluids in Emergency Scenarios and Settings
Published on: November 9, 2016
Implementation of a national system for best practice delivery of paediatric infusions
Moninne M Howlett1,2, Sharon Sutton3,4, Eimear L McGrath3
1Children's Health Ireland, Dublin 2, D12 N512, Ireland. moninne.howlett2@nchg.ie.
Insights
Standardizing paediatric infusions with a smart-pump drug library significantly reduced prescribing errors. This national initiative enhanced patient safety and compliance across Irish hospitals, establishing a new standard of care.
Area of Science:
- Pharmacology
- Patient Safety
- Healthcare Informatics
Background:
- Standard concentration infusions and smart-pump technology are recognized best practices in pediatric care.
- European hospitals show low implementation rates for these advanced infusion methods.
- Children's Health Ireland (CHI) developed a standardized pediatric smart-pump drug library.
Purpose of the Study:
- To expand best pediatric infusion practices by nationalizing the use of the CHI drug library.
- To improve medication safety and administration accuracy in pediatric and neonatal care.
- To establish a national standard for smart-pump drug library implementation.
Main Methods:
- The CHI drug library was developed over 10 years, expanding from 42 to 223 drug lines and incorporating a neonatal sub-library.
- Implementation involved securing executive support, dedicated resources, and developing training packages.
- The library was deployed across CHI, neonatal/pediatric transport services, neonatal units, and general pediatric sites in Ireland.
Main Results:
- A before-and-after study showed a significant reduction in infusion prescribing errors from 29.0% to 8.4% (p < 0.001).
- Direct observation revealed high compliance (98.9%) and low programming errors (1.6%) with the smart-pump system.
- Nurses reported enhanced patient safety, with 100% agreement 9 months post-implementation.
Conclusions:
- Strategic planning and collaboration are key to standardizing infusion practices nationally.
- The CHI drug library has been approved as a National Standard of Care in Ireland.
- Ongoing implementation of the drug library is continuing across healthcare facilities.
Background:
Standard concentration infusions and 'smart-pumps' are recognised as best practice in the paediatric setting. Implementation rates in European hospitals remain low. Children's Health Ireland (CHI) developed a paediatric 'smart-pump' drug library using standardised concentrations. At time of development, other Irish hospitals continued to use traditional pumps and weight-based paediatric infusions.
Aim:
To expand best paediatric infusion practices by nationalising use of the CHI drug library.
Setting:
Tertiary paediatric, maternity and general acute hospitals, and associated transport services in Ireland.
Development:
The CHI drug library was first developed for paediatric intensive care and then adapted over a 10-year period for use in emergency departments, general paediatric wards, neonatal units, adult intensive care and transport services. The original library (42 drug lines, 1 'care-unit') was substantially expanded (223 drug lines, 6 'care-units'). A neonatal sub-library was created.
Implementation:
Executive support, dedicated resources and governance structures were secured. Implementation and training packages were developed. Implementation has occurred across CHI, in paediatric and neonatal transport services, 58% (n = 11) of neonatal units, and 23% (n = 6) of paediatric sites.
Evaluation:
A before and after study demonstrated significant reductions in infusion prescribing errors (29.0% versus 8.4%, p < 0.001). Direct observation of infusions (n = 1023) found high compliance rates (98.9%) and low programming errors (1.6%). 100% of nurses (n = 132) surveyed 9 months after general ward implementation considered the drug library had enhanced patient safety.
Conclusion:
Strategic planning and collaboration can standardise infusion practices. The CHI drug library has been approved as a National Standard of Care, with implementation continuing.
Related Concept Videos
01:25Routes of Drug Administration: Parenteral
The intravenous route (IV) of drug administration can be further categorized into two types. The bolus injection administers the entire dose rapidly, while an intravenous infusion slowly delivers smaller doses steadily.
The IV route is often...
01:09One-Compartment Model: IV Infusion
The one-compartment model for IV infusion uses mathematical equations to describe the rate of change in drug quantity in the body. At steady-state or infusion equilibrium, the drug input...
01:29Drug Delivery: Parenteral Route
There are three primary parenteral routes: intravenous (IV), intramuscular (IM), and subcutaneous (SC). The IV route introduces the drug directly into the bloodstream, ensuring immediate action. The IM route...
01:27Parentral Nutrition: Centeral and Peripheral Parental Nutrition
PN can be administered through two primary routes:
1. Central Parenteral Nutrition (CPN):
CPN involves delivering a high concentration of nutrients through a large vein. This is typically achieved using a Peripherally Inserted Central Catheter (PICC) or,...
01:15Two-Compartment Open Model: IV Infusion
The model illustrates the decrease in plasma drug concentration from the central compartment with a specific equation. It shows that under steady-state conditions, the drug's input rate...
01:19One-Compartment Open Model for IV Bolus Administration: General Considerations
The drug's presence in the body is defined by an equation representing the difference between the rates of drug entry and exit. Key parameters—elimination rate constant,...