Background Continuous subcutaneous infusions (CSCI) are a corner stone of symptom management in palliative care, delivering consistent drug levels to patients where the oral route is not available or reliable (1). To achieve good symptom control it is important that CSCI are started and replenished promptly. It was noted that CSCI were frequently not being set up in accordance with the University Hospital Leicester (UHL) guidelines, whereby CSCI should be administered within 2 hours from recommendation if medication is ward stock or 4 hours if not. There were also delays in CSCI replenishment and monitoring.
Methods 50 patients with CSCI prescriptions were identified randomly from the LRI palliative care inpatient list. Demographic data, recommendation, prescription, and replenishment times plus monitoring data was collected prospectively over a 3-month period from electronic drug charts, medical and nursing notes. A standard of 100% compliance with UHL guidelines was set. Re-audit was undertaken 6 months later following intervention.
Results Whilst the standard was not met in either cycle, the percentage of CSCI containing ward stock medication administered with in 2 hours of recommendation increased from cycle 1 (30%) to cycle 2 (55%). Additionally, there was a decrease in the mean length of time from recommendation to administration (213 minutes 1st cycle and 172 minutes 2nd cycle).
Conclusion Initial interventions including educating ward staff and palliative care link nurses, plus the introduction of syringe driver board magnets to highlight patients with CSCI may have had some impact on CSCI practice at LRI. Continued work is needed to maintain the momentum of this project and sustain change. Incorporating CSCI alerts and reminders into the hospital electronic system represents an important next step, along with empowering and supporting wards to monitor their own practice routinely. The work is due to be replicated at other UHL sites.
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