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