Becton, Dickinson And Company · NYSE:BDX
Becton, Dickinson And — BD Medication Delivery Solutions Symposium 2020
33 slides from Becton, Dickinson And's conference presentation, April 2020
Slide 1: These presentations were developed by the respective presenter(s)
These presentations were developed by the respective presenter(s), and the findings, interpretations, and conclusions contained or expressed with them do not necessarily reflect the views of BD. To the extent these presentations relate to specific products, such products should always be used in acc
Slide 2: Pharmacist's role in vascular access
Pharmacist’s role in vascular access • Highlight which injectable preparations may/always require administration via a central venous access device. • Provide information on pH and osmolarity on recommended dilutions so you can make a judgement on appropriate access. This is just one part of the pha
Slide 3: Injectable Medicines Guide
Coa] | E=) Start | 7 Medusa HomepageHon X [+ Vv <€< - O A @ | wwwainjguide.nhs.uk/LogonCheck.asp Tarme and eanditinne | Canwrinht User: Susan Keeling Injectable Medicines Guide ont College Use the menu bar at the top right-hand corner of this page to select an activity. Each main function area has a
Slide 4: NHS Medusa injectable medicines guide website
NHS Medusa injectable medicines guide website Questions for the audience – Who is from the UK? – Is it used in your organisation? – Is it easy to find on your local intranet? – Is it linked to electronic prescribing systems? – Does your version link to local guidelines? If the answer is ‘no’ to any
Slide 5: NHS Medusa injectable medicines guide website
NHS Medusa injectable medicines guide website Aim of presentation – What is it – Why does it exist in the UK – What does it try to achieve – How is it used – What problems does it try to solve
Slide 6: Historical problems
HISTORICAL PROBLEMS Information available on safe preparation and administration available from lots of different sources BUT • No one source documented all necessary information • Manufacturers information does not provided everything you need to know • Locally produced guidelines of variable quali
Slide 7: IV Drug Administration error
IV Drug Administration error • Approx. 237 million medication errors in England annually - 28% have potential to cause patient harm (1) • Risk of errors is higher for IVs than for other routes of administration (3,4) • Recent review suggests 10.1% of IV doses in UK contain an error (5) • WHO (2017)
Slide 8: Infusion Preparation
Infusion Preparation Preparation • Mg - 6 out of 30 Samples contained 4-5 times too much Mg (Wheeler et al ICM 2008) Wednesday March 21st Milan
Slide 9: Complex drug regimens
Complex drug regimens • Progressively more complex drug regimens being prescribed. • Limited robust information available. RESULTING IN – local guidelines produced – Many different infusion concentrations in use for the same drug – Limited market for new ready to use products
Slide 10: The solution
The solution • 1988 paper IV guide for one hospital. • Guide was out of date almost immediately – 30 years later I am still doing it. • Early on other hospitals started to adapt the guide for local use. • New problem created - Many local guides. All different and of variable quality. • Consortium es
Slide 11: NPSA Alert 20 (2007)
NPSA Alert 20 (2007) Milan Wednesday March 21st Milan
Slide 12: NPSA (2007) recommends the injectable medicines guide
NPSA (2007) recommends the injectable medicines guide Wednesday March 21st Milan
Slide 13: The Injectable Medicines Guide website is born
THE INJECTABLE MEDICINES GUIDE WEBSITE IS BORN - Aims to reduce duplication of effort across the UK and help make poor quality out of date guidance redundant - A collection of drug monographs with all necessary information in one place. - Separate adult and paediatric versions
Slide 14: Up to date guidelines – the solution
Up to date guidelines – the solution • A comprehensive (referenced) user guide available to ALL is needed (NPSA alert 20) • Multidisciplinary input essential • Centrally held, up-to-date, user friendly and easily accessible 24 hours a day – Injectable medicines guide website (‘Medusa’) – Produced by
Slide 15: How often is it used?
HOW OFTEN IS IT USED? • In some hospitals, wards have full access and these typically reach usage of over 10,000 monographs per month • Some hospitals provide printed copies to wards • Some hospitals, a Pharmacy information source only • Usage • Typical usage – 350,000 monographs per month • Usage o
Slide 16: When is it used?
When is it used? Monographs by day of week (quarterly) 140000 136000 132000 128000 124000 120000 116000 112000 108000 104000 100000 96000 92000 88000 84000 80000 15
Slide 17: What time of day is it used
What time of day is it used Monographs by hour of day (quarterly) 70000 60000 50000 40000 30000 20000 10000 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 16
Slide 18: What does a monograph try to do?
What does a monograph try to do? • Interpret the SmPC and package leaflet in a user friendly way. • Fill in the gaps missing in other resources e.g. BNF – licensed products only. • Highlight important differences between different generics. • Link to new medicine related ‘issues’ can be added. • Lin
Slide 19: Who produces the website
Who produces the website • Hospitals either have pharmacists writing monographs or subscribe • UKMI pharmacist provide QA • Manufacturers asked to comment on all drafts • Multidisciplinary advisory board lead on content
Slide 20: Nursing advantages
Nursing advantages • Reduce time spent on infusion preparation because all necessary information is in one place • Simplifying preparation should help reduce error: – Calculation errors – Reconstitution errors – Diluent errors – Infusion rate errors – Labelling errors 19
Slide 21: 'Help' text and why it helps
‘Help’ text and why it helps Monograph headings have ‘help’ text to explain information in each heading and the rationale for the stated information.
Slide 22: Where does Medusa recommendation on central administration come from?
Where does Medusa recommendation on central administration come from? Previous RCN Standards for infusion therapy: Central administration for preparations • pH less than 5 or over 9 • Osmolarity greater than 600mOsmol/L Current VHP guidelines (see ‘help’ text) match this. Pharmacists need a referenc
Slide 23: Method of administration section
Method of administration section • States if an infusion must be administered via a central venous access device e.g. potent vasodilators. • ‘This medicine’ has a low/high pH/osmolarity and may cause venous irritation and tissue damage in cases of extravasation. If a central venous access device is
Slide 24: Management of extravasation
MANAGEMENT OF ETRAVASATION • Work going on to produce a generally acceptable management of extravasation guideline to include all IV’s not just cytotoxics which can be adapted locally if necessary. Medusa will include this once it is finalised. • ‘Documents and links’ page of website has local guide
Slide 25: Where does infusion pump recommendations come from?
Where does infusion pump recommendations come from? • No document specifies which infusions should be given using a pump • Paediatrics: Pump recommended for all infusions. • Adults: MHRA guidance for HCP’s on using and managing infusion systems – Dec 2013 – now withdrawn but still available and used
Slide 26: Example calculations and an electronic rate calculator
Example calculations and an electronic rate calculator • NPSA Alert request to include in ‘Medusa’ monographs • Impossible to do because :- ➢ Locally areas had standardised on a set of infusion concentrations but these differed across the UK ➢ SmPC’s recommend a diluent but often do not recommend a
Slide 27: Infusion concentrations – the problem
Infusion concentrations – the problem • Infusions traditionally made in clinical area so subject to personal opinion • Manufacturer/BNF provides information on diluent to use but not necessarily the dilution to prepare. – Multiple methods locally adopted – often inconsistent not just between hospita
Slide 28: Why are standard infusion concentrations needed?
Why are standard infusion concentrations needed? • Helps to avoid confusion day to day and when staff move. • Example calculation tables which work for most scenarios can be added to monographs. • ‘Big Pharma’ can consider new ready to use preparations with a bigger market – lower cost. • Drug libra
Slide 29: Infusion concentrations – the solution
Infusion concentrations – the solution • National surveys to establish standard infusion concs acceptable to most (adults and paeds) • Recommended list (endorsed by ICS/FICM) produced - includes 16 commonly used infusions. More under discussion. • Critical care areas encouraged to use the list. • Me
Slide 30: Example calculation
EXAMPLE CALCULATION: @ The infusion rate can be calculated from the following equation: Dose (micrograrrs/minute)x 60 (minutes) Glyceryl trinitrate infusion rate (mL/shour) = Cc tration (ni en) oncentration (micrograrre/m. For example: To administer a dose of 100micrograms/minute of glyceryl trinitr
Slide 31: The future
THE FUTURE • Medusa Advisory board needs more input from nurses and medics. Currently top heavy with pharmacists. • Redesign of website based on Bath university project • App • Other routes • Cytotoxics • BNF dose link to top of monograph. We have purposely not included doses as doing so is a potent
Slide 32: References
References • 1. Elliott RA, Camacho E, Campbell F, et al. Prevalence and economic burden of medication errors in the NHS in England. Policy Research Unit in Economic Evaluation of Health & Care Interventions; 2018. 2. Medication without harm - Global Patient Safety Challenge on Medication Safety. Ge
Slide 33: Further information on the website
Further information on the website Please come and talk to me today OR Email me Keeling.susan@nhs.net Demonstration version of website www.injguide.nhs.uk User name: Ivdemo Password: Bolus7
Becton, Dickinson and Company — BD Medication Delivery Solutions Symposium 2020 on 6ix