Implementation of pharmaceutical infusion management to reduce incompatibilities and fluid overload: a retrospective observational study in a paediatric intensive care unit.

Abstract

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.