Recording the time of administration of gentamicin doses by nursing staff

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Background & Problem

Gentamicin, a narrow-therapeutic index aminoglycoside antibiotic, is used for the treatment of numerous severe infections and surgical prophylaxis but is associated with serious side-effects including nephrotoxicity and ototoxicity (1). Hence, monitoring of gentamicin levels is fundamental. Within GHNHSFT, gentamicin levels should be done 12-18 hours post dose (2).

For accurate interpretation, it is essential to know the time of administration. However, this is often omitted by nurses. Consequences include inappropriate repeat levels, dose adjustments and switches to alternative IV antibiotics.

Data collection and PDSA cycles were implemented across wards 5A and 5B as they were identified as having gentamicin frequently prescribed.

Aim

By the end of December 2018, there will be an increase in the compliance of nurses recording time of administration for gentamicin doses (excluding stat doses) to 50% on the drug charts across wards 5a and 5b from a current baseline of 25.9%.

Method

A total of 3 PDSA cycles were done: use of pharmacist prompts through highlighted stickers; posters displayed in various locations on the wards; a new gentamicin policy and pilot chart insert which had a specific box to record the time of administration.

Results

There was a general upward trend from baseline. By the third PDSA cycle, the mean frequency of doses with time of administration stated, had increased from 25.9% to 100%, when the pilot chart was in use, when there was a specific box to record the time of administration. Hence, the project aim had been met.

Implications

By increasing nurse engagement through applied prompts; introducing new drug inserts, combined with nursing education, helped to achieve the aim. With PDSA cycle 3 being the most successful with use of the chart inserts, it has highlighted a need for an area on the drug chart for the time of administration to be recorded.

References:

(1) Hospira UK Limited. Gentamicin 40mg/ml Injection. Maidenhead: Electronic Medicines Compendium; 2018 [accessed 02 Jan 2019]. Available from: https://www.medicines.org.uk/emc/product/6531/smpc

(2) Jackson R, Ahearne D. Once Daily Gentamicin: Administration and Monitoring in Adults. Gloucestershire: Gloucestershire NHS Foundation Trust; 2018 [accessed 02 Jan 2019]. Available from: https://www.gloshospitals.nhs.uk