{
  "abstract": "Aim The policy drive to move paediatric and neonatal care from infusions based on patient weight to standard concentration infusions (StdC) is incontrovertible. There is little guidance to support the implementation of this intervention in district hospitals and neonatal units. 1 This study aimed to design an intervention to support StdC implementation using qualitative methods following the Medical Research Council’s Framework for Development of Complex Interventions.2 Method We used resilience engineering as our central theoretical framework, 3 4 and the Functional Resonance Analysis Method (FRAM) for our analysis. We observed infusion practice in England, in one neonatal unit and two paediatric units. Six real infusions and eight simulated infusions were observed. Observations were analysed sequentially, iteratively producing a FRAM diagram to identify points of variance and potential control interventions. To validate the FRAM we conducted 11 interviews with nurses (3), resident doctors (1), pharmacists (1), advanced practitioner (1) and consultants (5). A prototype intervention was developed using these analyses.Results The process was not linear and presented several cognitive challenges. Preparation and prescribing were conducted concurrently to make best use of time and support the team. All tasks could be adapted if required. There were five sources of variance; 1) Staff and skills: Nursing staff were seen as the drivers of the process, and supported other practitioners; 2) Information sources: practitioners used written sources that were familiar to them, or interpreted local guidelines through their previous experience and memory, or the experience of those around them; 3) Prescribing systems: Paper prescribing for infusions was common, but some sites used electronic systems which were operationally challenging to reconfigure. Paper systems permitted flexibility and adaptation; 4) Equipment: Practitioners would use whatever they could find to complete the task; 5) Technical processes: The process for making up an infusion was driven by local custom and practice or previous experience.Participants wanted an intervention that was pre-configured to minimise documentation/calculation processes and that provided immediate feedback to support verification of rate and dose parameters, and some instruction on how to prepare the infusion. This could be paper based or digital, but paper offered more resilience according to some participants.The prototype intervention consisted of a single printed sheet with a prescribing tool consisting of TWO elements to be completed (rate and dose), a rate checking tool and a step-by-step process to prepare the infusion incorporating directed check points.Conclusion Infusion prescribing is an uncommon task in district hospitals. Prescribing and preparation practices are not defined in the context of other influencing factors and so are adaptive. Participants wanted simple protocols and cognitive support for prescribing, preparation and administration. Calculations, equipment requirements and clear instructions on what to do were most important to them. Technological interventions were viewed as important but were time-consuming to validate and deploy. A simple paper template was developed from this study.The intervention requires feasibility testing in a simulated environment to evaluate effectiveness. Future electronic implementation guidance should incorporate standard parameters for the main Electronic Patient Record systems in use.References Lau SYL, Arenas-Lopez S, Sutherland AB. Implementing smart pumps and standard infusions in paediatric care: a scoping review BMJ Paediatrics Open 2025;9(Suppl2):A15.Skivington K, Matthews L, Simpson SA, et al. A new framework for developing and evaluating complex interventions: update of Medical Research Council guidance. BMJ 2021;374:N2061.Fairbanks RJ, Wears RL, Woods DD et al. What is Resilience and Resilience Engineering in Health Care? Joint Commission Journal on Quality and Patient Safety 2014;40(8):376–83.Sujan M, Ibrahim M, Booth L et al. Embedding resilience engineering in an applied safety research programme. Contemporary Ergonomics and Human Factors 2022:158–60.",
  "authors": [
    {
      "affiliations": [
        "University Of Bradford, UK"
      ],
      "name": "Adam Sutherland"
    },
    {
      "affiliations": [
        "Evelina London Children’s Hospital, UK"
      ],
      "name": "Sara Arenas-Lopez"
    },
    {
      "affiliations": [
        "Royal Manchester Children’s Hospital, UK"
      ],
      "name": "Ralph Mackinnon"
    },
    {
      "affiliations": [
        "Cambrensis, UK"
      ],
      "name": "David Slater"
    }
  ],
  "title": "SP9 Standardising infusions in paediatric and neonatal care: next steps (The SIXPENCE Study)",
  "uid": "478e35a1-5bac-5440-9948-08b7a3dd00d6"
}