TABLE 4. Recommendations for Competency and Quality in Subcutaneous Infusion Therapy.

Recommendation
38. Organizations should establish systems to ensure that all health care professionals involved in prescribing and/or administering subcutaneous infusions are trained on the principles covered in these recommendations and are then formally assessed and reassessed at regular intervals to demonstrate competence (knowledge, skills, and judgment).31,34,35,38 (IV)
39. Organizations should consider designating clinician lead/resource for infusion therapy, responsible for training, clinical governance, audit and review of subcutaneous fluid prescribing, and patient outcomes.8 (V)
40. Organizations should monitor quality outcomes related to subcutaneous infusion therapy. [C]
41. Consider quality standards such as: i) infusion fluids clinical lead/resource; ii) health care professionals' competencies; and iii) identifying and reporting consequences of fluid mismanagement (eg, pulmonary edema or hypovolemia).8 (V)
42. Encourage and participate in research to promote evidence-based decision-making and clinical practice in the administration of subcutaneous infusions of hydration and medications.38 (V)

Abbreviations: (I), level I evidence: systematic review of randomized controlled trials; (II), level II evidence: randomized trial or observational study with dramatic effect; (III), level III evidence: non-randomized controlled cohort/follow-up (post marketing surveillance) study; (IV), level IV evidence: case series, case-control studies or historically controlled trials; (V), level V evidence: single descriptive and qualitative studies, mechanism-based reasoning (pathophysiologic rationale), expert opinion from clinicians or authorities; (C), level [C] evidence: consensus by research committee.