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ELIMINATION OF THE RULE-OF-SIX IN A TERTIARY HOSPITAL

European Statement

Patient Safety and Quality Assurance

Author(s)

Mohammed Almeziny, Ali Alkhudair , Fahad Alkharji

Why was it done?

The Rule-of-Six has been used in hospitals for many years. in the last years it has been under investigations due to the variable concentrations that result when making the calculation to mix critical medication drips. The rule, or formula, multiplies a patient’s weight (Kg) by 6 to determine the dose of a medication (mg) to be added to an appropriate diluents for a total volume of 100 mL. The rate in mL/hr is equivalent to the dose in mcg/kg/min. Therefore, for each patient, there would be a different concentration infused, although the rate/dose would be the same. In addition, the drastic changes in a patient’s weight would require compounding a new drip.

What was done?

developed and implemented a standardised list of IV medication concentrations across a tertiary hospital to enhance medication safety.

How was it done?

A task group was formulated from all involved parties to standardise I.V. infusion concentrations. The task group adopted the following strategies: first strategy is enhancing safety through standardised and limited concentrations available, simplifies calculations and minimise its effect on fluid restriction patients. Second strategy the concentration should be broadly applicable through meets needs of 80-90% patients, frequently used in current practice and appropriate for peripheral as well as central lines and the third strategy is developing comprehensive IV references using guideline validated by expert review and stakeholder consensus, education and training of stakeholders, comprehensive drug information, appendices for specialty settings and populations (ICU, NICU etc) and index of commercially available ready to administer finally these strategies are subjected to periodic revision and update. Infusion charts were developed to facilitate use of standardised concentration

What has been achieved?

Within 9 months the task group were able to eliminate the rule of six and created a list of standardised IV concentration. The hospital has successfully implemented a standardised IV infusion concentrations. The multidisciplinary consensus was achieved. The list of standardised IV concentration meets patient safety goals and provides numerous safety features. In addition system is highly efficient on a day to day practice as well as it is highly adaptable to most patient groups.

What next?

The health information system will be used to calculate the infusion rate

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