Implementing a point-of-care activated system for amoxiclav-1g infusion in nursing wards : obstacles and key factors for success
3 octobre 2010M. Courtois1, O. Hamdan2, N. Brousmiche2, J. Adant1, B. Lemaitre2, J. Douchamps1 1 Pharmacy department, CHU de Charleroi (CHUC), André Vésale Hospital, Montigny-Le-Tilleul, Belgium
2 Centre de Santé des Fagnes Hospital (CSF), Chimay, Belgium
Amoxicillin clavulanate (amoxiclav), due to its low chemical stability once reconstituted, is a perfect candidate for point-of-care activated systems (POCAS), a method which enables rapid reconstitution of less stable intravenous (i.v.) molecules at the patient bedside. Although recommended by the 2 US Consensus on Safety of i.v. Drug Delivery Systems (2000 ; 2008) and despite its widespread use in our CHUC (>20,000 doses/y since 2007, conditioned in isolator), this concept remains virtually unknown in Belgium. Our objective was to test the POCAS’ acceptability in a hospital where nurses were unaware of its existence.
2 Materials & Methods
13 nurses from CSF, shortly trained to POCAS technical manoeuvres, were required, on their daily routine, to perform 10 alternatively infusions of amoxiclav-1g with either the traditional “syringe and needle” method or with the POCAS method. On each POCAS occasion, they evaluated 9 criteria by means of 100mm visual analogue scales with reference to the traditional method’s value = 50 mm).
The comparisons between POCAS and traditional methods revealed a strong preference for the former (non-parametric comparisons to a reference value for repeated measures).
An ANOVA of Friedman for repeated measures with post-hoc tests comparing the 10 sessions 2-by-2 revealed that the majority of nurses progressed rapidly from poor to excellent ratings.
4 Discussion and conclusion
In the Belgium setting, POCAS method required from naive nurses only short training and habituation periods to be fully efficient and its acceptability was excellent with regard to safety and ease of use.