Critical Care Medicines Optimisation: IV to Enteral Switching and Continuous Tazocin Dosing

Team members

Dr Katherine Laver, Dr Ed Smith, Dr Anthony Harding, Dr Arusa Latif, Hannah Nasol, Dr Kira Ford-Busson, Dr Shreya Srikumar, Suhail Patel and Carum Kooner. 

Setting / patent group: 

The project was undertaken within the General Critical Care and Cardiothoracic Critical Care units at UHCW. It focused on critically ill adult patients receiving intravenous medications and antibiotic therapy.

Issue:

Critical care patients often receive intravenous (IV) medications that require substantial volumes of fluids, single-use consumables, and packaging. These practices contribute to carbon emissions, waste production, increased costs, and potential risks associated with prolonged IV therapy and fluid overload. The team identified opportunities to improve sustainability by reducing unnecessary IV medication use and redesigning the way Tazocin antibiotics are administered.

Intervention: 

Two sustainable quality improvement initiatives were introduced. The first promoted switching IV paracetamol, phosphate, and proton pump inhibitors to enteral alternatives where clinically appropriate. This was achieved through staff education, medication reviews, bedside prompts, and multidisciplinary engagement. The second supported the introduction of Continuous Tazocin Infusions (CTIs), replacing intermittent antibiotic dosing with a more efficient delivery method that uses fewer consumables, reduces waste, and aligns with emerging evidence of improved clinical outcomes.

Outcomes:

Clinical

The IV-to-enteral switch project supported medicines optimisation without compromising patient care and encouraged more appropriate use of intravenous therapies. The CTI project was associated with predicted improved antibiotic delivery for patients with sepsis, with modelling suggesting the intervention could contribute to preventing more than 11 deaths per year across the critical care units.

Environmental

A 30% reduction in IV medication use was projected to save approximately 1,919 kgCO₂e annually. Introducing Continuous Tazocin Infusions could save a further 1,163 kgCO₂e per year, reducing the carbon footprint of Tazocin administration by more than 54%. Together, the projects are estimated to save 3,082 kgCO₂e annually, equivalent to approximately 9,173 miles driven in a petrol car

Financial

The switch from IV to enteral medications was projected to generate cash releasing annual savings of approximately £42,475 through reduced medicine and consumable use. The CTI pathway could deliver an additional £14,764 cash releasing annual saving, resulting in a combined estimated financial benefit of £57,239 per year.

Social
The project strengthened staff engagement with sustainable healthcare and demonstrated strong support from nursing, pharmacy, and medical teams. Both interventions reduced nursing workload by decreasing medication preparation time, reducing the need for multiple medication checks, and freeing up staff time to focus on direct patient care. The project also increased awareness of sustainability within critical care practice and supported the Trust's Green Plan objectives.

Key learning point 

Small changes to prescribing and medication administration practices can deliver substantial environmental, financial, and clinical benefits. The project demonstrated that sustainable healthcare improvements can be successfully embedded into routine critical care practice through multidisciplinary collaboration, staff education, and a focus on interventions that improve both patient outcomes and resource efficiency.