Safe, patient-controlled intravenous pain relief in children Evelina Children’s Hospital

The Evelina Children’s Hospital team developed a safe, patient-focused management system for delivering opiates to children. The aim of the project was to minimise the risk of medication errors in nurse or patient-controlled analgesia (N/PCA), by avoiding complex calculations and the need to make up individualised medicines at the point of administration.

The project team introduced standard dose-banded concentrations of morphine infusion for N/PCA, made aseptically and delivered through pre-programmed safety pumps. They trained medical staff to use the new system, developed instructions for patients, reconfigured the safety pumps and wrote protocols for using and storing the infusions.

Who was involved

The project was led by a consultant paediatric pharmacist and member of the paediatric pain team. Other team members included senior pharmacists, a senior pharmacy lecturer and the head of pharmaceutics and drug delivery at King’s College London.

Outcomes

• 20 paediatric patients received standardised morphine infusions for N/PCA.
• Early anecdotal data suggested that the system was easy to use, safe and much quicker than the existing system.
• The system was well received by anaesthetists and nurses. Staff felt that the use of colour-coded protocols and labels lowered the risk of incorrect selection.

Challenges

The project faced delays as anaesthetists questioned whether published results on the accuracy of ward-based infusions would be similar to theatres. This led to extra work in analysing syringes made up in theatres and by nurses on wards. Finding safe storage for the prefilled syringes was another challenge.