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ARE PRESCRIBED INFUSIONS RUNNING AS INTENDED?


Figure 2 shows the distribution of selected infusions by department. The duration of each infusion is shown in Figure 3.


Less than 1 min


over 5 hrs 1 to 15 min


The data from the logs represent a snapshot of a period of approximately 16 days per log. Although our estimated number of infusions only accounts for a fraction of the total number of infusions over the entire 3-year period, the logs provide valuable insight into how infusion regimes are administered and managed in practice.


6 to 10 min 1 to 5 hrs Results 31 to 60 min 11 to 30 min


Mean duration of infusion The mean duration of infusions from the logs was 3 hours 20 minutes. The breakdown by department in Figure 4 shows that the midwifery department has the longest infusions, lasting on average just under 5 hours.


Frequency of restarts per infusion Fifty-six percent of all infusions (2061) were administered without interruption or disruption.


Figure 3: The durations of infusions found in the logs 4h 55min 3h 53min 3h 55min 3h 9min 2h 44min 1h 29min


Figure 5 shows a detailed breakdown of the infusions and how often they were restarted. There were nine cases where the infusions were restarted over 20 times and four cases where they were restarted over 40 times. Analysis of the data showed that the top four events that disrupt an infusion were: excess pressure, where pump momentarily pauses infusions as it detects a build-up in pressure (1973); user action, where a user pauses the infusion using a key (1345); no fl ow above pump, where the clamp has been left closed, bag empty or fl uid bag needs to be repositioned to allow fl ow (880); and air bubbles in pump cassette (441). Other events included door open (114), occlusion (77) and dead battery (58).


Oncology Medical Midwifery Anaesthetic Surgical Paediatrics Figure 4: Average duration of each infusion in minutes


the laboratory. Infusions run at high rates (above 500 ml per hour) for short durations (less than 1 minute) were removed. In total, 444 intended infusions were removed from the study.


Finally, 3681 intended infusions from 128 infusion pumps and 270 log fi les were analysed. We shall henceforth use ‘infusion’ to refer to intended infusion, as defi ned above. Over half of all the infusions selected for analysis were from the oncology department.


Distribution of infusion regimens The frequency of each combination of VTBI and infusion rate is shown in Figure 6. The histogram has the frequency of intended infusions up to a VTBI of 1000 ml. From Figure 6, one can identify two clusters where more than a third of all the infusions lie: one group has a VTBI close to 1000 ml at a rate of to 125 ml per hour, creating infusions with a duration of 8 hours; and the other group has infusions with a maximum VTBI of 200 ml at rate between 0.1 and 300 ml per hour (i.e., with infusions lasting from ten minutes up to an hour). The majority of cases have a particular combination of 100 ml at 200 ml per hour (with the infusion lasting 30 minutes). These ranges are often used for antibiotic therapy, but the specifi c use cannot be easily identifi ed from the logs. From the histogram, however, it is possible to identify a


BJN July 2013 CareFusion Supplement 17


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