Fluid and drug administration in a paediatric critical care: prospective, single centre, multimodal, direct observational study

Abstract Critically ill children are intensively monitored and receive many drugs, fluids, and other therapies while in paediatric intensive care unit(PICU). The operational aspects of the provision of these therapies are not well understood. The objective of this study was to characterise the activities supporting fluid and drug administration in critically ill paediatric patients. This prospective, single centre, observational study used multi-modal direct observation approach (video, audio, and direct bedside observation) to understand the clinical activities associated with care of critically ill children. Administration was separated into the broad and varied activities required for drug and fluid administration ranging from drug information review through disposal. 43 patients, 84 nurses, 43 doctors, 27 respiratory therapists and 4 nurse practitioners were observed over 48 epochs and 143.15 h. The 23.61(16%) hours of drug and fluid therapy observed were comprised of 660 specific clinical administrations of drug and fluid therapy that took a median(IQR) 64.45(17.10–163.62) seconds and were comprised of 4396 administration activities. Interruptions to the process of drug and fluid administration were also counted and observed 261 times, occurring in 148(22%) of unique administrations and lasted a median(IQR) of 7.95(3.82–14.88) seconds each. This study has implications on safety measures pertaining to sources and duration of interruptions within administration, as well as considerations around nursing tasks, ratios and sheer workload of drug and fluid administration. Further work could explore targeting strategies that optimize efficiency, workflow, and safety in the PICU as it pertains to layout, staffing and ease of medication administration.