JMIR Publications

ABSTRACT

Background:

There is an unmet need for reliable medication stability information to avoid sub-optimal administration of intravenous medications that may lead to reduced efficacy of therapy, and potential patient harm through medication degradation, and incompatibilities causing vascular access issues.

Objective:

To develop evidence-informed guidance for pharmacists and nurses on the use of material administration lines materials, in-line filtration, and light protection during storage and intravenous administration for medications commonly used in critical care and oncology.

Methods:

An initial list of 181 medications was compiled in consultation with pharmacist stakeholders from critical care and oncology specialties. A modified Delphi study was conducted over three rounds with a panel of eight expert pharmacists selected for their clinical expertise, professional experience, and geographic location to represent the diversity of healthcare settings and medication administration practices. Panelists anonymously ranked on a 5-point Likert Scale statements developed from review of the literature with respect to the requirement for specific administration line material for each medication; the need for, and type of, filtration required during administration; and the need for light protection during storage and administration of medications. After each round, items achieving 80% consensus were finalized. Those without consensus moved to the next round. This iterative approach allowed the panelists to reconsider their ratings based on emerging group consensus and additional evidence shared by panelists between rounds.

Results:

A total of 1,044 administration and storage requirements were assessed for 174 medications. In Round 1 consensus was reached for 613 (58.7%) statements. Panelists provided additional evidence sources for their decisions, and this was distributed to all panel members for Round 2. By the conclusion of Round 3 consensus was achieved for 692 (66.3%) statements.

Conclusions:

This study developed consensus-based recommendations for selection of administration line materials, use of in-line filtration and light protection for administration and storage of a range of medications given intravenously. The guidance will aid medication stability and efficacy and promote good clinical practice; it currently underpins a bedside application for correct intravenous administration line selection for nursing and pharmacy staff in critical care and oncology units. Clinical Trial: Not Applicable