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Implementation of pharmaceutical infusion management to reduce incompatibilities and fluid overload: a retrospective
Mona Kleinlein1, Karin Stuebinger2, Michael Hoeckel1
1Pharmacy, Gesundheit Nordhessen Holding AG, Kassel, Germany.
Insights
Pharmaceutical infusion management significantly reduced fluid overload in paediatric intensive care unit (PICU) patients. This quality improvement strategy also decreased drug incompatibilities and fluid administration volumes.
Area of Science:
- Pediatric Intensive Care
- Clinical Pharmacy
- Quality Improvement
Background:
- Fluid overload is a significant contributor to morbidity in pediatric intensive care units (PICUs).
- Effective management of fluid balance is crucial for improving patient outcomes in critical care settings.
Purpose of the Study:
- To evaluate the impact of pharmaceutical infusion management on reducing fluid overload in routine pediatric intensive care.
- To assess the effectiveness of a quality assurance measure in optimizing fluid administration and drug compatibility.
Main Methods:
- A retrospective observational study comparing a control period with a period implementing pharmaceutical infusion management (PharmInfuManagement).
- PharmInfuManagement involved optimizing flushing schedules and reducing dilution volumes for intravenous drugs.
- Primary outcome was the incidence of patients with ≥5% fluid overload; secondary outcomes included furosemide dose, drug volume, and incompatibilities.
Main Results:
- A significant reduction in fluid overload (≥5%) was observed, decreasing from 52% to 29% (p=0.01).
- Flushing volumes were reduced from 0.7 to 0.3 mL/kg/day (p<0.001).
- Potentially incompatible drug combinations decreased from 17.1% to 8.2% (p<0.001), and dilution volumes reduced from 8.8 to 6.8 mL/kg/day (p=0.02).
Conclusions:
- Pharmaceutical infusion management is an effective strategy for reducing fluid overload in PICU patients.
- This approach successfully minimizes drug incompatibilities and decreases unnecessary fluid administration.
Introduction:
Fluid overload is associated with increased morbidity in patients in paediatric intensive care units (PICUs). This study aimed to evaluate pharmaceutical infusion management as a quality assurance measure to reduce fluid overload in routine paediatric intensive care.
Methods:
This was a retrospective observational study in a PICU with two periods: a control period and a period after the implementation of pharmaceutical infusion management (PharmInfuManagement period). Pharmaceutical infusion management consisted of two components carried out simultaneously: the creation of flushing schedules to reduce incompatibilities and flushing volume and the reduction of dilution volume for six non-continuous intravenous (IV) drugs to reduce fluid intake because of IV drugs. The primary outcome was the number of patients with ≥5% fluid overload. In addition, daily furosemide dose (mg/kg/day), non-continuous IV drug volume (mL/kg/day), flushing volume (mL/kg/day) and number of incompatibilities were evaluated.
Results:
Sixty-six patients were included in each period. Fluid overload of ≥5% occurred in 52% of patients in the control period and in 29% of patients in the PharmInfuManagement period (p=0.01). Flushing volume decreased from 0.7 mL/kg/day (median Q25/Q75 0.4/1.4) to 0.3 mL/kg/day (median Q25/Q75 0.1/0.7) (p<0.001) after implementation. During the PharmInfuManagement period, potentially incompatible drug combinations were reduced from 17.1% (86/504) to 8.2% (43/523) (p<0.001). The volume required for reconstitution and dilution of non-continuously administered IV drugs was reduced from 8.8 mL/kg/day (median Q25/Q75 7.1/12.6) to 6.8 mL/kg/day (median Q25/Q75 5.5/8.0) (p=0.02).
Conclusion:
Pharmaceutical infusion management reduces incompatibilities and fluid overload in PICU patients.
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