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

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

2. 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

3. Gentamicin pharmokinetic information Gentamicin 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.

4. Neonatal Nurses Association PSA Background to alert development

5. What does the alert say?

6. 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

7. Ensure local policies include bundle 24-hour clock Coloured apron Double-checking Dose within one hour Local protocol • The prescribed dose of gentamicin should be given within one hour of the prescribed time • 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 • A double-checking prompt should be used during the preparation and administration of gentamicin • 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 Use care bundle PDSA cycle Measurement Training

8. Double checking prompt Local protocol Use care bundle PDSA cycle Measurement Training

9. PDSA cycle applied to gentamicin

10. 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)

11. Three steps to measurement

12. Care bundle compliance chart Care bundle daily audit chart Complete the compliance chart Extranet / run chart 243 128 4627 01/01/2010 16.07

13. Care bundle compliance chart Care bundle daily audit chart Complete the compliance chart Extranet / run chart

14. Care bundle compliance chart Care bundle daily audit chart Fill out the audit chart and totals Extranet / run chart

15. Care bundle compliance chart Care bundle daily audit chart Upload audit totals on the extranet Extranet / run chart From the daily audit chart

16. Care bundle compliance chart Care bundle daily audit chart Upload audit totals on the extranet Extranet / run chart

17. 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

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

19. Principles of therapeutic drug monitoring Be sure to follow your local gentamicin policy when progressing through the above principles

20. 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

21. Queries about the alert • Please email gentamicin@npsa.nhs.uk or call 020 79279514