Guidelines for Safe Infusion Practices in Emergency and Acute Care Settings: Society of Acute Care Trauma and Emergency Medicine Delphi Consensus Statement
Lokendra Gupta, Om Prakash Sanjeev, Utsav Anand Mani, Subhankar Paul, Ashish Bhalla, Haider Abbas, Avinash Agrawal, Rajeshwari Sanjay Vhora, Tanmay Tiwari, Vimala Venkatesh, Yash Javeri, Shiv Shankar Tripathi, Pravin Kumar Das, Tarun Sharma, Somnath Longani, Jobin Jose Maprani, Abhay Raj Yadav, Ratna Kumar Natta, Nayan Sriramula, Anjani Priya Vemula, Dontula Madhu Kiran, Arun Kumar Pandey, Pushpraj SinghAbstract
Background:
Infusion therapy forms an integral part of emergency/acute care medicine, and there continue to be many challenges, such as infusion errors, catheter-related complications, infections, medication errors, and occupational health concerns, in the delivery of safe intravenous therapy. Hence, this Society for Acute Care Trauma and Emergency Medicine guideline sought to provide evidence-based recommendations for safe infusion practices in acute emergency situations.
Methodology:
A systematic Delphi consensus process was undertaken. The operational definitions for safe infusion practice were defined by the steering committee. Evidence was obtained from searches conducted within PubMed/MEDLINE, EMBASE, Cochrane Database, World Health Organization, Centers for Disease Control and Prevention, Infusion Nurses Society, Institute for Safe Medication Practices, Joint Commission and other sources. The strength of recommendation was scored using a five-point Likert scale.
Results:
One hundred and one recommendations were made within 11 categories, which include training and technology, hand hygiene, difficult venous access, peripheral venous catheter insertion and management, infusion processes, infusion technology, prevention of drug administration errors, waste management, training methods and telemedicine/arteficial intelligence. Sixty-three recommendations had reached a high degree of consensus, 24 reached a medium degree of consensus and 14 were considered weak. A total of 55 recommendations reached consensus in the first iteration of the Delphi process, and 46 needed modification/re-evaluation. The scores of agreement were between 72.4% and 97.2%.
Conclusions:
The recommendations developed by the current study can serve as a systematic and practical approach to ensure infusion safety in the setting of emergency and acute care.