Lorianne Wright

Implementation of Standardized Concentrations for Continuous Infusions Using a Computerized Provider Order Entry System

Medications given by continuous infusion are a mainstay of therapy in pediatric and neonatal intensive care units. Administering medications by this method allows for titration of doses by simple rate adjustments. Many pediatric hospitals have traditionally used weight-based calculations such as the “rule of six” to determine the concentration to which a medication will be diluted. The “rule of six” calculation involves multiplying the patient’s weight by six to determine the amount of drug in milligrams to be added to 100 mL of diluent. The infusion rate then equals the dose in mcg/kg/min. This formula, while providing an easy method to determine rate adjustments, can lead to medication errors due to the many possible concentrations that are required to meet the needs of patients of varying weights. One of the 2005 National Patient Safety Goals set by the Joint Commission of Accreditation of Healthcare Organizations required institutions to standardize and limit the number of drug concentrations available in order to prevent medication errors. All institutions must implement this standard by 2008. This paper describes the development of standard concentrations at the Monroe Carell Jr. Children’s Hospital at Vanderbilt and the implementation of the standards using our computerized provider order entry system (CPOE).

Analysis of 72-Hour Sterility of Common Pediatric Continuous Intravenous Infusions

OBJECTIVES Patient morbidity and mortality associated with contaminated and improperly prepared sterile products has captured national attention. In response, both the United States Pharmacopeia (USP) and Centers for Disease Control (CDC) have published recommendations in an effort to minimize the risk of infection. While the CDC recommends that administration sets are not changed more frequently than every 72 hours, the USP recommends a maximum beyond use date of 48 hours. Neither organization provides specific guidance on expiration dating once the intravenous drug is dispensed. Likewise, neither addresses the length of time that a bag containing medication for continuous infusion may hang once administration to the patient has begun. We evaluated the sterility of medications that are commonly administered by continuous infusion to pediatric patients. Because frequent manipulation of infusion and administration sets may predispose the patient to adverse events, we evaluated sterility for extended beyond use dating up to 72 hours. METHODS Thirty-five common intravenous (IV) continuous infusions using 94 standard concentrations and diluents were identified. IV solutions were mixed using sterile technique in the laminar flow hood in accordance with USP guidelines. Medications were excluded for short stability, short durations of use or high cost. A sample from each solution was tested for contamination or bacterial growth at 72 hours. Any visible discoloration suggesting physical instability was also evaluated. RESULTS None of the syringes or chambers resulted in contamination, bacterial growth or discoloration after 72 hours. CONCLUSIONS This study provides sufficient data that these compounded sterile products may be stored using a beyond use date up to 72 hours for a number of commonly used continuous IV infusions in pediatric patients. In our institution, this allows for a more convenient and consistent change of both administration sets and continuous infusions at 72 hours to potentially minimize adverse events, workload and cost.

Computerized decision support for intravenous fluid management in pediatric patients

This continuing feature describes the clinical pharmacy support tools and services that are provided by the computerized provider order entry (CPOE) system at Vanderbilt University Medical Center (VUMC) — with an emphasis on pediatrics. The authors focus on the development and maintenance of decision support tools created specifically for use in the pediatric population.

Improving communication and safety with CPOE decision support tools

This continuing feature describes the clinical pharmacy support tools and services that are provided by the computerized provider order entry (CPOE) system at Vanderbilt University Medical Center (VUMC) — with an emphasis on pediatrics. The authors focus on the development and maintenance of decision support tools created specifically for use in the pediatric population.

Expansion of pharmacokinetic services through the electronic health record using CPOE and computerized note capture tools

This continuing feature describes the clinical pharmacy support tools and services that are provided by the computerized provider order entry (CPOE) system at Vanderbilt University Medical Center (VUMC) — with an emphasis on pediatrics. The authors focus on the development and maintenance of decision support tools created specifically for use in the pediatric population.

Implementation of Pediatric-Specific Decision Support in a CPOE System

This continuing feature describes the clinical pharmacy support tools and services that are provided by the computerized provider order entry (CPOE) system at Vanderbilt University Medical Center (VUMC) — with an emphasis on pediatrics. The authors focus on the development and maintenance of decision support tools created specifically for use in the pediatric population.

The pharmacist's role in CPOE: A pediatric perspective

This continuing feature describes the clinical pharmacy support tools and services that are provided by the computerized provider order entry (CPOE) system at Vanderbilt University Medical Center (VUMC) — with an emphasis on pediatrics. The authors focus on the development and maintenance of decision support tools created specifically for use in the pediatric population.