How often do you receive queries about an aspect of intravenous (IV) drug administration? How often do you hear questions such as, "what is a suitable diluent?", "what is the minimum volume a drug can go in?", or "over what period should a drug be given?".

Local guidelines

In most hospitals the clinical or medicines information pharmacists are the first port of call for such advice. In an attempt to minimise repetitive queries and standardise advice, many hospitals have produced local guidelines for IV administration of commonly used drugs. These are used not only by pharmacists but also by nursing staff at ward level. The guides ensure that accurate information is readily available and the use of a standard format reduces chances of misinterpreting the data.

The development of a local IV guide was initiated approximately 10 years ago by group members Sue Keeling, Jean Blake and Nina Barnett. It soon became clear that hospitals throughout the United Kingdom were undertaking similar projects and that much duplication of effort was occurring. The Intravenous Drug Administration Group was established to address this and to liaise with hospitals across the UK to facilitate production of standardised IV drug administration monographs.

To date this has been a paper exercise culminating in the production of 'The IV guide', which currently contains 450 IV drug administration monographs. Each monograph (see Panel 1) contains detailed information, including the preparation, dilution and administration of the drug together with other pharmaceutical information, some of which is not readily accessible or comprehensively contained in other reference sources. Participating hospitals are requested to maintain approximately five monographs each which are centrally edited and compiled into the guide. Each participating hospital receives a copy of the guide. Both demand for the guide and the number of monographs it contains has dramatically increased. This is mainly due to its success as a useful information resource within hospitals but also because of an increase in the number of commonly used IV drugs. Preparation and distribution of this guide have now become an onerous task.

A working group has thus been formed to develop and pilot an electronically available, interactive database which would meet these new, increasing demands. The database is being developed by Health Solution Wales, which provides information technology and telecommunications services to the NHS in Wales. It is expected that the database will be made available on NHSnet. The monographs will be held centrally and users, such as doctors, nurses, intensive therapy unit staff and pharmacists, will use passwords to access levels of information appropriate to their needs. Participating hospitals will remain responsible for their allocated monographs. However, electronic submissions together with central editing and review facilities will make this a more efficient process.

Tailored for local needs

The database can be tailored to meet local needs, for example, by monographs being linked to formularies or local specialist advice. It is hoped that the increasing use of computers by practitioners and access to this database at ward level will reduce the number of repetitive enquiries handled by clinical and medicines information pharmacists. Copies of the monographs will also be able to be printed if attachment to patient's drug chart or notes is required. Future developments may include dose calculation tools and adaptation for use on hand-held devices. A prototype of the database can currently be viewed by users of NHSnet (see Panel 2).

We believe 'The IV guide' is already a valuable resource for hospital pharmacists. The developments of this into an accessible interactive electronic database will allow timely and accurate dissemination to all hospital users. The success of this project, however depends on the active participation of pharmacists to help maintain and update the information held. We would thus like to take this opportunity to welcome new members to the scheme and thank those who have already contributed.

Readers who would like to find out more about the guide and how their hospitals can participate are asked to contact Gill Bullock (e-mail GBullock@hhnt.org).