P-26 Challenging the pressure on nhs resources: could 48-hour continuous subcutaneous infusions (CSCIS) help? a systematically-structured review of the current evidence base

Background The majority of patients express a preference to die at home, yet the most commonly recorded place of death is hospital; in 2012, 36.7% of deaths in Liverpool occurred in the person’s usual place of residence. With an ageing population, NHS resources will be placed under increasing pressure to meet the needs and care preferences of chronically ill patients. Accordingly, innovative approaches to existing therapies are one way to improve care and maximise service delivery. For example, the ability to deliver prescribed medication by CSCI over 48 hours may have numerous benefits in both patient care and health service resource utilisation: current practice limits infusion time to a maximum of 24 hours due to available chemical and microbiological stability data. Aim To examine the evidence on stability of 48 hour multiple-drug syringes/CSCIs in current clinical practice. Design A systematically-structured review following PRISMA guidelines. Data sources Three electronic databases (CINAHL, EMBASE and MEDLINE) and grey literature were searched with no time limits. Studies published in English reporting empirical data on the chemical or microbiological stability of continuous subcutaneous infusions or solutions stored in polypropylene syringes were included. Results Chemical compatibility and stability of 51 different combinations of 12 drugs were reported across the ten studies included in this review. Of the 51 combinations reported, all 51 were assessed as being chemically compatible after 48 hours at ambient temperatures (20–26°C). Midazolam appears to be drug at greatest risk of clinically significant chemical degradation. Microbiological stability was only reported for one combination. Conclusions There is currently limited evidence for the physical, chemical and microbiological stability of solutions for continuous subcutaneous infusion over a period of 48 hours. More stability data is required before the use of 48 hour CSCIs can be evaluated for use within clinical practice. Acknowledgements This project was funded through a grant from NHS Liverpool CCG.