NSW Health has adopted a statewide approach to the governance and use of medicines administered via continuous infusion to reduce duplication of effort, improve resource efficiency, and support the safe, high-quality and equitable use of medicines across health services.
We are developing an overarching Policy Directive to:
- outline the requirements for NSW Health facilities to use the standardised continuous infusion concentrations and
- establish the governance for continuous infusion concentrations and volumes available within the Single Digital Patient Record.
Out of scope continuous infusions
Some medicines included in this guidance may also be administered intermittently. Intermittent administration is outside the scope of this project, which applies only to continuous maintenance infusions.
The following continuous infusions and infusion groups are outside the scope of the NSW Standardised Continuous Infusion Concentrations project and are not included in this guidance:
- Acetylcysteine (adults and paediatrics)
- Antibiotic infusions
- Ciclosporin
- Continuous nebulised medicines
- Epidural and regional analgesia
- Intrathecal infusions
- Maintenance fluids
- Medicines administered via continuous renal replacement therapy (CRRT) or extracorporeal membrane oxygenation (ECMO) circuits
- Palliative care continuous subcutaneous infusions (CSCIs)
- Parenteral nutrition
- Patient-controlled analgesia (PCA) or nurse-controlled analgesia (NCA)
- Tacrolimus
Decision-making principles
The Clinical Excellence Commission Continuous Infusions Adult and Paediatric Working Groups applied a consistent, evidence-based approach to determine recommended standardised continuous infusion concentrations. Continuous infusion concentrations and volumes were selected as those applicable to most patient care circumstances, recognising that exceptions may be clinically required in a small proportion of cases.
In selecting standardised concentrations, the working groups considered the following principles.
Safety and evidence
Stability and safety of concentrations were supported by recognised references, including product information and authoritative medicines resources. Every effort was made to ensure that the concentrations selected had no identified safety concerns related to the route of administration, stability, or infusion rate.
Consistency and simplicity
The number of concentrations and weight bands per medicine (and route, if relevant) was minimised where possible to support standardisation, usability and system safety.
Clinical feasibility
Concentrations were assessed for practical use in routine clinical care, including:
- provision of an appropriate infusion duration at common doses
- minimisation of unnecessary fluid or volume load
- for paediatric infusions, consideration of administration rates across each weight band.
Preparation practicality and waste reduction
Where possible, concentrations were selected to enable preparation using whole vials or ampoules or standard volumes (such as 1 mL) to reduce complexity, preparation variability and medicine wastage.
Product availability and Formulary alignment
Preference was given to concentrations that use commercially available premade bags or prefilled syringes, where available, and Formulary‑listed products, where appropriate.
Consensus‑based decision making
Final concentrations were determined through multidisciplinary consensus, informed by current NSW practice and expert clinical judgement.
Alignment of paediatric concentrations with adult and neonatal concentrations
Where possible, the highest and lowest paediatric concentrations were aligned with the standardised concentrations for adult and neonatal patient groups, respectively.
Acknowledgements
We acknowledge and thank the many clinicians, partners and networks who consulted and collaborated on the standardisation and guidance. We acknowledge the contributions of the Agency for Clinical Innovation, the Australasian Neonatal Medicines Formulary Group, the CEC Continuous Infusions Adult and Paediatric Working Groups, eHealth NSW, Single Digital Patient Record Implementation Authority, HealthShare NSW and the numerous clinicians and subject matter experts across NSW Health who were consulted and provided advice and expertise throughout this work.