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the child will receive 1 mg of the compounded medication. However, if the medication is compounded in 1 mg of solution, the child will receive an overdose; conversely, if the drug is compounded with 100 mg of solu- tion, the child will not receive appro- priate doses.
Varying concentrations in com- pounded IV admixture pose greater potential for adverse events, from severe debilitation to patient death. Reports for adverse events include inappropriate solution concentra- tion for anticoagulation medicines administered during heart surgeries and opiates used to manage cancer patient pain.8
Children’s hospitals are espe- cially susceptible to concentration- related problems because patients arrive from across the country.
Concentration protocols vary from state to state, as well as from pro- vider to provider, and hospital phar- macists must be extremely vigilant in monitoring and adjusting the concentration variants.7
To address such issues, the FDA awarded a three-year contract to ASHP to develop and implement na- tional standardized concentrations. The resulting initiative, Standardize 4 Safety, is the rst national, inter- professional effort to standardize medication concentrations, reduce medication errors and improve tran- sitions in patient care.9
The multi-phased project was launched in May 2016. Phase I, now completed, includes standardized concentrations and dosing for adult continuous infusions and compound- ed oral medicines. Phase II, set to
launch in 2017, addresses standard- ized concentrations for pediatric medications. Phases III and IV, slated for 2018, standardizes the doses in IV intermittent medications, patient- controlled analgesia (PCA) pumps and oral chemotherapy treatments.
Expert panels select the appropri- ate concentrations of medications. ASHP is collaborating with other professional organizations, including the Association for the Advancement of Medical Instrumentation (AAMI), Pediatric Pharmacy Advocate Group (PPAG), the Institute for Safe Medication Practices (ISMP), as well as local, state and national health organizations.10
Additional information about Standardize 4 Safety, including drafts open for discussion and joining the initiative, is available at ashp.org.
Sources
1Cristina Boccuti and Gisiselle Casilias, Aiming for Fewer Hospital U-turns: The Medicare Hospital Readmission Reduction Program, September 30, 2016, accessed January 2017 at kff.org
2Jennifer Splawski, PharmD, BCPS, and Healther Minger, PharmD, BCPS, Value of the Pharmacist in the Medication Reconciliation Process, March 2016, accessed February 2017 at ncbi.nlm.gov
3Marija Markovic, PharmD, A. Scott Mathis, PharmD, et al, A Comparison of Medication Histories Obtained by a Pharmacy Technician Versus Nurses in the Emergency Department, 2017, accessed January 2017 at ptcommunity.com
4Marilyn Bulloch, PharmD, BCPS, Pharmacists Can Help Overcome Challenges in Care Transitions, January 4, 2017, accessed January 2017 at pharmacytimes.com
5Sanchez, GM et al., Revisting Project Re-Engineered Discharge (RED): The Impact of Pharmacist Telephone Intervention on Hospital Readmission Rates, September 2015, accessed February 2017 at ncbi.nlm.nih.gov 6Anthony Vecchione, Study shows benefits of a centralized pharmacy-led prior authorization process, November 11, 2016, accessed January 2017 at drugtopics.modernmedicine.com
7Anthony Vecchione, Health System pharmacists embrace medication standardization campaign, September 10, 2016, accessed February 2016 at drugtopics.modernmedicine.com
8Institute for Safe Medication Practices, 2016–2017 Targeted Medication Safety Best Practices for Hospitals, accessed February 2017 at ismp.org
9ASHP Press Release, Standardize 4 Safety Initiative Releases Final IV Recommendations for Medication Safety, October 25, 2016, accessed February 2017 at ashp.org
10American Pharmacy News Reports, ASHP announces launch of Standardize 4 Safety program, May 10, 2015, accessed February 2017 at americanpharmacynews.com
34 | InsideOut
Standardize 4 Safety is the
first national, interprofessional effort to standardize medication concentrations.