‘safer use of intravenous gentamicin for neonates’ how-to guide

‘Safer use of intravenous gentamicin for neonates’ how-to guide

Why do we need an alert?

• Used in 89 per cent of neonatal units• Over 500 patient safety incidents reported to NPSA

in 2008/2009• Side effects include vestibular and auditory

damage, and nephrotoxicity• Narrow therapeutic range necessitates regular

monitoring of blood serum concentrations

Gentamicin pharmokinetic informationGentamicin is a broad spectrum aminoglycoside antibiotic which is widely used in the treatment of neonatal infection. It is not absorbed intestinally and therefore is given by injection. It is associated with a risk of kidney damage and hearing impairment. Adverse effects are particularly associated with patients with poor renal function and where higher gentamicin blood levels and longer duration of therapy have been used.

Background to alert development

PS

A

Neonatal Nurses Association

What does the alert say?

Develop a local gentamicin protocol

• A local protocol is available that clarifies:• The initial dose and frequency of

administration• Blood level monitoring requirements• Arrangements for subsequent dosing

adjustments based on blood levels taken

Ensure local policies include bundle

Local protocol

Use care bundle

PDSA cycle

Measurement

Training

•24-hour clock format should be used when prescribing

•Unused time slots in prescription administration record should be blocked out at time of dosing to prevent wrong time dosing

•Interruptions during the preparation and administration of gentamicin should be minimised by the wearing of a disposable coloured apron by staff to indicate that they should not be disturbed

•The prescribed dose of gentamicin should be given within one hour of the prescribed time

•A double-checking prompt should be used during the preparation and administration of gentamicin

24-hour clock Coloured apron

Double-checking

Dose within one hour

Double checking prompt

Local protocol

Use care bundle

PDSA cycle

Measurement

Training

PDSA cycle applied to gentamicin

Add more patients after each cycle

• Start the actions in the alert for one patient and move through the PDSA cycle

• When your run chart shows at least 80 per cent compliance add more patients and start the cycle again

• This process should be repeated from one patient, to three, to five, etc. (this is the 1:3:5 approach)

Three steps to measurement

Complete the compliance chart

Care bundle compliance

chart

Care bundle daily audit

chart

Extranet / run chart

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Complete the compliance chart

Care bundle compliance

chart

Care bundle daily audit

chart

Extranet / run chart

Fill out the audit chart and totals

Care bundle

compliance chart

Care bundle

daily audit chart

Extranet / run chart

Upload audit totals on the extranet

Care bundle compliance

chart

Care bundle daily audit

chart

Extranet / run chart

From the daily audit chart

Upload audit totals on the extranet

Care bundle compliance

chart

Care bundle daily audit

chart

Extranet / run chart

Helpful resources

• In addition to these slides you can also expect the following resources to aid in your implementation:• Instructional Webinar presentations• FAQs published on the website• Resources on PDSA cycles and

measurement from the Patient Safety First and 1000 Lives campaign websites

Therapeutic drug monitoring: why do it?• Prevent drug toxicity• Ensure drug efficacy

Principles of therapeutic drug monitoring

Be sure to follow your local gentamicin policy when progressing through the above principles

Support with the measurement extranet• Patient Safety First Office: 020 79279569 or

www.patientsafetyfirst.nhs.uk • 1000 Lives Office (Wales): 029 20827651 or

www.1000livescampaign.wales.nhs.uk or the 1000 Lives Campaign contact for the Health Board

Queries about the alert

• Please email gentamicin@npsa.nhs.uk or call 020 79279514