An Economic Analysis of Critical Care Nurse Resourcing Following the Uptake of Ready-to-Administer Noradrenaline for Hypotensive Shock in Adults in England

• Published in: Advances in therapy Vol. 39; no. 1; pp. 727 - 737
• Main Authors: Griffin, Edward, Tweedie, Oliver, Kirk-Bayley, Justin
• Format: Journal Article
• Language: English
• Published: Cheshire Springer Healthcare 01-01-2022
• Subjects: Administration, Intravenous; Adult; Cardiology; Cost-Benefit Analysis; Critical Care; Endocrinology; England - epidemiology; Humans; Internal Medicine; Medicine; Medicine & Public Health; Norepinephrine - therapeutic use; Oncology; Original Research; Pharmacology/Toxicology; Rheumatology; Syringes; England; Nursing; Ready-to-administer; Medication safety; Budget impact; Noradrenaline; Hypotensive shock; Resource-saving
• ISSN: 0741-238X; 1865-8652
• DOI: 10.1007/s12325-021-02003-2

Introduction
Ready-to-administer formulations for intravenous administration of noradrenaline are now broadly recommended and predicted to reduce pressure on critical care nursing. This analysis sought to quantify the nurse resource released from national level transition.
Methods
The annual number of noradrenaline support days for hypotensive shock was determined and the administration of noradrenaline was simulated over 24 h using a decision tree. A ‘best-practice’ ready-to-administer strategy (RtA) of volumetrically pumped noradrenaline was compared to a ‘nil uptake’ strategy (AfC) of bedside prepared solution delivered either volumetrically or using a double syringe pump. A mix of noradrenaline concentrations, flow rates, product sizes, and preferences for ampoule pooling, preparation volume, and sterility were included. The consumption of nurse days and product units was then projected over 1 year for a population of adults in critical care in England.
Results
Noradrenaline was administered over 231,011 days per year across 4123 critical care beds in England. Implementing a transition from AfC to RtA strategies on this scale released 35,791 nurse days or 176 whole-time nurse equivalents at 50/50 NHS band 5 and 6, a monetised release of £11.6 million. There was an increase in drug acquisition cost of £2.1 million using the licensed commercial product Sinora
®
. Annual net monetary benefit was + £9.5 million, or + £65,961 per critical care unit (CCU) of 29 beds, equivalent to one nurse released per unit for patient care.
Conclusions
This modelling of ready-to-administer noradrenaline with volumetric delivery quantifies and bears out the recommendations of the Lord Carter review, the Royal Pharmaceutical Society, and the NHS Specialist Pharmacy Service in their encouragement of ready-to-administer formulations for safe and resource-effective critical care.