Background Continuous subcutaneous infusions (CSCIs) are often used in the palliative care setting where patients require regular medication but the oral route is not available. Symptoms may include debilitating pain, nausea or seizures so medication should be started promptly after clinical review. While there is no clear definitive time frame for these, we would aim for infusions to begin within 2 hours, with anything above 4 hours an unacceptable delay.
This study took place at the Queen Elizabeth Hospital, Birmingham UK and its purpose was to determine whether CSCIs are being commenced promptly after being prescribed.
Methods Using the electronic data system, we looked at all of the patients to have a McKinley infusion commenced, and who were referred to the palliative care team during the period 1 April – 31 July 2018.
Results 104 patients fitted the inclusion criteria. 45% of infusions were commenced within 2 hours and a total of 74% were commenced within 4 hours. The mean time to start (TTS) was 225 minutes (range 14–1581 minutes). There were 9 infusions that took over 600 minutes (10 hours) to be commenced. These affect mean calculations considerably.
Discussion One common reason cited by ward staff was the prescriber not informing nurses that they had prescribed a CSCI. We noted that a prescriber can prescribe remotely from another ward in the hospital, giving barriers to good verbal handover to nurses. Other reasons cited include prescriptions being erroneous and having to be re-prescribed, or having to wait for Mckinley pumps to be delivered by equipment stores. This study highlights an important patient experience issue for individuals towards the end of life, and additionally for prescribers. The very best medical knowledge and nursing skill can be undone by an avoidable delay in the commencement of a basic infusion.
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