An evaluation of continuous subcutaneous infusions across seven NHS acute hospitals: is there potential for 48-hour infusions?
AffiliationPharmacy Department, Royal Liverpool University Hospital, Prescot Street, Liverpool
MetadataShow full item record
AbstractBackground: Continuous subcutaneous infusions (CSCIs) are commonly used in the United Kingdom as a way of administering medication to patients requiring symptom control when the oral route is compromised. These infusions are typically administered over 24 h due to currently available safety data. The ability to deliver prescribed medication by CSCI over 48 h may have numerous benefits in both patient care and health service resource utilisation. This service evaluation aims to identify the frequency at which CSCI prescriptions are altered at NHS Acute Hospitals. Methods: Pharmacists or members of palliative care teams at seven acute NHS hospitals recorded anonymised prescription data relating to the drug combination(s), doses, diluent and compatibility of CSCIs containing two or more drugs on a daily basis for a minimum of 2 days, to a maximum of 7 days. Results: A total of 1301 prescriptions from 288 patients were recorded across the seven sites, yielding 584 discrete drug combinations. Of the 584 combinations, 91% (n = 533) included an opioid. The 10 most-common CSCI drug combinations represented 37% of the combinations recorded. Median duration of an unchanged CSCI prescription across all sites was 2 days. Conclusion: Data suggests medication delivered by CSCI over 48 h may be a viable option. Before a clinical feasibility study can be undertaken, a pharmacoeconomic assessment and robust chemical and microbiological stability data will be required, as will the assessment of the perceptions from clinical staff, patients and their families on the acceptability of such a change in practice. Keywords: CSCI; Palliative therapy; Subcutaneous infusions.
CitationBaker J, Dickman A, Mason S, Bickerstaff M, Jackson R, McArdle A, et al. An evaluation of continuous subcutaneous infusions across seven NHS acute hospitals: is there potential for 48-hour infusions? BMC Palliat Care. 2020;19(1):99.
JournalBmc Palliative Care
- Identification of drug combinations administered by continuous subcutaneous infusion that require analysis for compatibility and stability.
- Authors: Dickman A, Bickerstaff M, Jackson R, Schneider J, Mason S, Ellershaw J
- Issue date: 2017 Mar 23
- The current evidence base for the feasibility of 48-hour continuous subcutaneous infusions (CSCIs): A systematically-structured review.
- Authors: Baker J, Dickman A, Mason S, Ellershaw J
- Issue date: 2018
- Continuous subcutaneous infusion for pain control in dying patients: experiences from a tertiary palliative care center.
- Authors: Fürst P, Lundström S, Klepstad P, Strang P
- Issue date: 2020 Nov 10
- A national survey of inpatient medication systems in English NHS hospitals.
- Authors: McLeod M, Ahmed Z, Barber N, Franklin BD
- Issue date: 2014 Feb 27
- The need for chemical compatibility studies of subcutaneous medication combinations used in palliative care.
- Authors: Rose M, Currow DC
- Issue date: 2009