Authors: (including presenting author): :
Lui YL(1), Chan CSS(1), Poon C(2), Ng WYJ(3), Li TY(3), Lam CHH(1), Wong CY(1), Wong YY(1), Tse KYG(1)(2)(3)
Affiliation: :
(1) Intensive Care Unit, Department of Medicine and Geriatrics, Ruttonjee and Tang Shiu
Kin Hospitals,
(2) Coronary Care Unit, Department of Medicine and Geriatrics, Ruttonjee and Tang Shiu
Kin Hospitals,
(3) Department of Medicine and Geriatrics, Ruttonjee and Tang Shiu Kin Hospitals
Keyword 1: :
Double pumping
Keyword 2: :
Patient safety
Keyword 3: :
Inotrope infusion
Introduction: :
Intravenous inotropes are vital for managing hemodynamic instability in critically ill patients. However, interruptions during syringe changes can cause sudden, life-threatening blood pressure (BP) fluctuations. To improve safety, a quality improvement (QI) program was implemented in Ruttonjee and Tang Shiu Kin Hospitals (RTSKH), introducing a standardized double-pumping infusion system. The program aimed to enhance patient safety and strengthen nurses’ competency and confidence in handling high-risk vasoactive medications.
Objectives: :
The project aimed to (1) reduce hemodynamic instability during inotrope transitions; (2) improve nurses’ knowledge, skills, and adherence to a standardized inotrope infusion protocol; and (3) establish a sustainable, evidence-based workflow for safe medication administration.
Methodology: :
Based on best-practice literature, overlapping inotrope infusions during syringe transitions were adopted. With ICU doctors’ approval, a standardized double-pumping workflow was established, where the second syringe driver runs before discontinuing the first. A train-the-trainer model enabled senior nurses in the Intensive Care Unit (ICU) and Coronary Care Unit (CCU) to lead simulation training, hands-on sessions, and bedside coaching using competency checklists, photo guides, and an instructional video. Over four months, data were collected on BP stability (>10% fluctuations from baseline), workflow compliance (monthly audits), and nurse knowledge and perceptions (pre- and post- training quizzes and staff evaluation surveys). Paired t-tests and descriptive statistics compared pre- and post-implementation results.
Result & Outcome: :
Across 56 post-implementation episodes, no acute BP fluctuations or adverse hemodynamic events were recorded. This represents a significant improvement from the previous 5% incidence. Post- education quiz scores increased by 40% on average (p value < 0.001), and compliance with the new workflow reached 100%. Among 45 participating nurses, 94% reported enhanced confidence and perceived safety in managing inotrope therapy. Implementing the double-pumping inotrope infusion system improved patient safety, maintained hemodynamic stability, and strengthened nursing competency. Initial challenges with the new workflow were addressed through ongoing mentorship and simulation. Sustained success will depend on continued training, periodic protocol review, and continuous compliance monitoring to align with emerging evidence.
