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Background The Medusa NHS Injectable Medicines Guide (IMG) is a national resource with over 7 million annual views, supporting injectable medicines preparation and administration. Intravenous (IV) ceftriaxone is the most accessed paediatric Medusa monograph (~140,000 hits/year), with specific paediatric considerations for safe and accurate administration. In April 2025, the ceftriaxone monograph was updated to align with new practice recommendations and simplify administration recommendations. Changes included:Standardising reconstitution concentration to 100mg/mL for all vial sizesSeparating preparation advice for injection versus infusionAllowing doses ≤50mg/kg to be administered by slow IV push over 5–minutesAllowing doses ≤80mg/kg to be infused over 10–minutes (excluding neonates)1 Aim To gather paediatric nursing feedback regarding the updated ceftriaxone Paediatric Medusa monograph to ensure practical, safe, and user-friendly guidance and to inform future workMethod A survey was conducted across two NHS Trusts:Trust 1 (uses a local IV guide) – 16 respondentsTrust 2 (uses Medusa IMG) – 7 respondents Survey responses (n=23) were summarised using descriptive statistics (percentages), both collectively and by trust, to identify practice variations.Results Reconstitution:To reconstitute a 2g vial with 18.6mL diluent: o ~70% would use a 20mL syringe (1mL graduations), estimating 18.6mL visually o ~30% would use a 10mL syringe (measuring 10mL and then 8.6mL)Dose preparation:To prepare a 2.8g dose: o 39% would use three 1g vials o 39% would use a combination of 2g + 1g vials o 30% would use two 2g vialsTo prepare large doses >60mL volume (e.g 3.3g @50mg/mL) methods included: o Two equal volume (33mL) syringes (~39%) o 100mL infusion bag (~30%) o 60mL + 6mL syringes (~22%) o 2g (40mL) + 1.3g (26mL) syringes (~9%)New practices:If written guidance permitted, 100% of nurses would be comfortable:Administering doses ≤50mg/kg as a slow push over 5 minutesInfusing doses ≤80mg/kg over 10–minutesPreferred changes:100% supported slow push administration for doses ≤50mg/kg91% preferred average displacement values over brand–specific87% preferred reconstitution volumes measurable with a single syringe74% favoured 10–minute infusions over 30–minutesMonograph preference:83% overall preferred the updated monographTrust 1: 100% preferred the updated versionTrust 2: 43% preferred the updated version (potentially due to familiarity with the previous version)Conclusion This survey highlighted that, despite specific injectable medicines guidance, practice regarding IV drug administration in paediatrics can vary significantly. Practical issues, such as syringe size and accurate dose measurement, must be considered when providing administration recommendations. The survey indicates that nurses are willing to adopt new practices if supported by Trust/national guidance. IV push administration of doses ≤50mg/kg was thought to have the greatest positive impact on nursing workload. Reducing infusion time from 30 to 10 minutes was deemed less beneficial. Incorporating nursing feedback ensures guidance is practical and safe for the end user. These findings will be used to refine the ceftriaxone Paediatric Medusa monograph further and inform future updates to other paediatric monographs.Reference Paediatric Innovation, Education and Research Network. Ceftriaxone: Practical prescribing guidance. Available from: https://www.piernetwork.org/ceftriaxone.html [Accessed 28 Apr 2025].