# Evaluation of NHS Injectable Medicines Guide users’ information needs related to the co-infusion of intravenous medicines: user survey and Delphi consensus study

## TL;DR

This study identifies the most important information healthcare workers need about mixing intravenous drugs and recommends expanding current guidelines to cover all infused drugs.

## Contribution

The study provides consensus-based recommendations for improving intravenous drug compatibility information in clinical practice guidelines.

## Key findings

- Most users co-infuse intravenous drugs weekly, with fluids, antibiotics, and analgesics being the most common.
- Users and experts agree that compatibility status, concentrations, and diluents are most important for drug compatibility information.
- Expert panel recommends providing compatibility information for all infused drugs, differing from current limited national guidelines.

## Abstract

To explore intravenous drug compatibility information needs of National Health Service (NHS) Injectable Medicines Guide (‘Medusa’) users. To develop consensus expert recommendations on the intravenous drug compatibility information that Medusa should include.

A convergent parallel design. An online survey of Medusa users. A three-round Delphi project developed expert consensus.

Community, secondary, tertiary and mental healthcare sites across the UK.

142 Medusa users completed the online survey (114 nurses, 28 pharmacists). A panel of 16 nurses and 25 pharmacists currently practising in the NHS with professional expertise relevant to the compatibility of injectable medicines participated in the Delphi project.

Users’ ratings of the importance of different types of compatibility information. Consensus expert agreement on a six-point scale regarding the compatibility information that should be provided by Medusa.

97 (68%, 95% CI 60 to 75%) users were involved in the co-infusion of drugs at least weekly. Most users reported co-infusing intravenous fluids (n=116, 82%, 95% CI 75 to 87%), antibiotics (n=85, 60%, 95% CI 52 to 68%) and analgesics (n=81, 57%, 95% CI 49 to 65%) in the past year. They considered information on whether drugs are compatible/incompatible, and the concentrations and diluents in which this occurs, most important (Friedman test p<0.001, Dunn-Bonferroni pairwise comparisons p≤0.028). The expert panel also identified these topics as important for all infused drugs, along with information on time frames, supporting data and specific requirements for the intravenous line (median agreement rating of both professions ≥5 with IQR ≤1.75 in each case).

The co-infusion of drugs is common, so supporting information continues to be important. The most relevant information is that identified by both users and the expert panel: whether drugs are compatible/incompatible, and the concentrations and diluents in which this occurs. The expert panel’s recommendation to provide information for all infused drugs contrasts with current more limited national recommendations.