Identification of drug combinations administered by continuous subcutaneous infusion that require analysis for compatibility and stability.
BACKGROUND
A continuous subcutaneous infusion (CSCI) delivered via syringe pump is a method of drug administration used to maintain symptom control when a patient is no longer able to tolerate oral medication. Several classes of drugs, such as opioids, antiemetics, anticholinergics, antipsychotics and benzodiazepines are routinely administered by CSCI alone or in combinations. Previous studies attempting to identify the most-common CSCI combinations are now several years old and no longer reflect current clinical practice. The aim of this work was to review current clinical practice and identify CSCI drug combinations requiring analysis for chemical compatibility and stability.


METHODS
UK pharmacy professionals involved in the delivery of care to palliative patients in hospitals and hospices were invited to enter CSCI combinations comprised of two or more drugs onto an electronic database over a 12-month period. In addition, a separate Delphi study with a panel of 15 expert healthcare professionals was completed to identify a maximum of five combinations of drugs used to treat more complex, but less commonly encountered symptoms unlikely to be identified by the national survey.


RESULTS
A total of 57 individuals representing 33 separate palliative care services entered 1,945 drug combinations suitable for analysis, with 278 discrete combinations identified. The top 40 drug combinations represented nearly two-thirds of combinations recorded. A total of 23 different drugs were administered in combination and the median number of drugs in a combination was three. The Delphi study identified five combinations for the relief of complex or refractory symptoms.


CONCLUSIONS
This study represents the first step towards developing authoritative national guidance on the administration of drugs by CSCI. Further work will ensure healthcare practitioners have the knowledge and confidence that a prescribed combination will be both safe and efficacious.
Marie Curie Palliative Care Institute Liverpool, Cancer Research Centre, Liverpool, L3 9TA, UK. a.dickman@liverpool.ac.uk.
Andrew
http://orcid.org/0000-0001-6493-8979
A
Dickman
Cancer Research UK Liverpool Cancer Trials Unit, University of Liverpool, Liverpool, L69 3GL, UK.
Matthew
M
Bickerstaff
Cancer Research UK Liverpool Cancer Trials Unit, University of Liverpool, Liverpool, L69 3GL, UK.
Richard
R
Jackson
School of Biomedical Sciences and Pharmacy, Faculty of Health and Medicine, University of Newcastle, Newcastle, Australia.
Jennifer
J
Schneider
Marie Curie Palliative Care Institute Liverpool, Cancer Research Centre, Liverpool, L3 9TA, UK.
Stephen
S
Mason
Marie Curie Palliative Care Institute Liverpool, Cancer Research Centre, Liverpool, L3 9TA, UK.
John
J
Ellershaw
D062126:Databases, Chemical; D004355:Drug Stability; D004359:Drug Therapy, Combination / Q000379:methods / Q000592:standards / Q000706:statistics & numerical data*; D019538:Health Care Surveys; D006801:Humans; D007260:Infusion Pumps; D055104:Infusions, Subcutaneous / Q000379:methods / Q000592:standards / Q000706:statistics & numerical data*; D010166:Palliative Care / Q000379:methods* / Q000706:statistics & numerical data*; D006113:United Kingdom
Delphi technique; Drug combinations; Infusions; Palliative medicine; Patient safety; Questionnaires; Subcutaneous; Surveys