Good Clinical Practice Guidance for Line Materials, Filtration, and Light Protection in Intravenous Medication Administration: Modified Delphi Consensus Study

BACKGROUND There is an unmet need for reliable medication stability information to avoid suboptimal administration of intravenous medications, which may lead to reduced efficacy of therapy and potential patient harm through medication degradation or incompatibilities that cause vascular access issues. OBJECTIVE This study aimed to develop evidence-informed guidance for pharmacists and nurses on the use of administration line materials, in-line filtration, and light protection during storage and intravenous administration of medications commonly used in critical care and oncology. METHODS An initial list of 181 medications was compiled in consultation with pharmacist stakeholders from critical care and oncology specialties. A modified Delphi study was conducted over 3 rounds with a panel of 8 expert pharmacists selected for their clinical expertise, professional experience, and geographic location to ensure representation of diverse health care settings and medication administration practices. Panelists anonymously ranked statements on a 5-point Likert scale developed from a review of the literature with respect to the requirement for a specific administration line material for each medication; the need for, and type of, filtration required during administration; and the need for light protection during storage and administration of medications. After each round, items achieving 80% consensus were finalized. Those that did not achieve consensus were carried forward to the next round. This iterative approach allowed panelists to reconsider their ratings based on emerging group consensus and additional evidence shared by panelists between rounds. RESULTS A total of 1044 administration and storage requirements were assessed for a final list of 174 medications. In round 1, consensus was reached for 613 (58.7%) statements, with every statement being addressed and scored by the panelists. Panelists provided additional evidence sources for their decisions, and these were distributed to all panel members for round 2. All items were addressed and scored by the panelists. By the conclusion of round 3, consensus had been achieved for 697 (66.8%) statements, with all items being addressed and scored by the panelists. CONCLUSIONS This study developed consensus-based recommendations for the selection of administration line materials, the use of in-line filtration, and light protection for the administration and storage of a range of medications administered intravenously. The guidance will aid medication stability and efficacy and promote good clinical practice; it currently underpins a prototype bedside app for correct intravenous administration line selection for nursing and pharmacy staff in critical care and oncology units.