E.D. Critical Care infusion stickers

Purpose Statement

Prescription stickers have been created for continuous infusions of vasoactive and sedative medications in CUH Emergency Department.

All these medications are for careful titration at the bedside until clinical stability is achieved, they are not 'set and forget'. The stickers are designed to increase efficiency and reduce delay/ distraction, whilst also providing key clinical guidance.

They are for use within Cork University Hospital ED only, covering only the medications in the following stickers (see below).

Standard medication names are used, abbreviations match those used on Braun Perfusor syringe driver/ Braun Informat pumps.

Standard colours are used to demarcate drug classes as per drug labelling stickers already in use in CUH and internationally.

• DS = double strength
• GTN = glyceryl trinitrate
• IVI = intravenous infusion
• MAP = mean arterial pressure
• SBP = systolic blood pressure

Pump limits (Soft and Hard)

Soft limit refers to usual upper limit of infusion dose rate which may sometimes by exceeded when clinical need cannot be met otherwise. The Hard limit is the absolute reached at which point no further rate increases are allowed by the Braun driver/ pump.

In these stickers, soft limits for maximum infusion rate are used unless not available, where hard limits are then used. This is to ensure that patients reaching these soft limits are identified early and have reassessment of care, including review by senior clinicians.

CUH IV guidelines

Individual monographs are hosted together at https://emed.ie/Pharmacology/IV_Admin.php.

Prescription is completed in standard way with prescriber signature and date.

The sticker is designed to be valid until such time it's cancelled (like any prescription). Critical care medication infusions are different to other prescriptions in that it's a single drug at variable rate with dynamic physiological target, and also includes a rate of zero- i.e. being ceased once target is reached.

It is very unlikely that any patient on these critical care infusions would remain in ED beyond 24 hours however, if so, then the prescription should be reviewed and renewed.