JMIR Publications

ABSTRACT

Background:

There is a paucity of information in the literature on core nursing staff knowledge on the requirements of specific intravenous administration lines for medications regularly given in critical care. There is also a lack of well-researched and appropriate information in the literature for IV-administration line selection, and the need for filtration, light-protection and other line-material selection precautions for many critical and non-critical medications used in these speciality areas to maintain their potency and efficacy.

Objective:

Creation of a verified and replicable survey tool to assess the knowledge base of clinicians of administration sets for critical care medications, and to triangulate the information obtained against data for administration line consumption and individual medication-type utilization. This evidence will be taken forward to suggest solutions of information availability for accurate selection of speciality IV-administration lines.

Methods:

Data was drawn from a clinician knowledge questionnaire, a region-wide database of administered infusions, and regional data on standard and specialty IV-administration lines consumption for one year from an Enterprise Resource Planning system log. The clinician knowledge questionnaire was validated with three control groups (n=35) and then released for a general survey of critical care nurses. (n=72) Prospective validation was made by review of response dispersal. (Cronbach’s Alpha = 0.8889) Correct answers were assessed by reference to the available literature and through consensus between the team’s pharmacists. Answers from the control and test groups were calculated as deviations from the correct answer (multiple selections). Mapping between the three sources of information was undertaken to identify the gap between required usage and real usage, and the knowledge deficit that impacts on this disparity.

Results:

Deviations by percentage from fully correct selections on the questionnaire were substantial in the control group and extensive in the test group. Confusion over the requirements for low-sorbing lines, light protection of infusions, and the requirement for filtration of specific solutions was evident. The data on projected specialty line requirement by medication type and actual consumption in the region showed a degree of disparity, with considerable underusage of lines that protect infusions from light, and possible over-usage for low-sorbing lines. In both the questionnaires and in the data on usage versus projected requirement there was considerable agreement on the need for speciality lines for Total Parental Nutrition.

Conclusions:

There is no single source of truth for clinicians on the interactions of critical care IV-medications and administration line materials and light, and on the need for filtration. It is evident that nursing staff have limited knowledge of these requirements. To reduce clinical variability in this area it is desirable to have succinct, easy to access information available for clinicians to make decisions on which administration line type to use for each medication.