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American Journal of Health-System Pharmacy, Vol. 67, Issue 1, 58-69
Copyright © 2010. American Society of Health-System Pharmacists, Inc. All rights reserved. 1079-2082/04/0602-1242$06.00

Case Studies

Implementation and evaluation of a comprehensive system to deliver pediatric continuous infusion medications with standardized concentrations

 Elora Hilmas, Azizeh Sowan, Mohamed Gaffoor and Vinay Vaidya

ELORA HILMAS, PHARM.D., BCPS, is Pharmacy Residency Coordinator, Department of Pharmacy, Alfred I. duPont Hospital for Children, Wilmington, DE. AZIZEH SOWAN, PHD., RN, is Assistant Professor,. School of Nursing, Hashemite University, Zarqa, Jordan. MOHAMED GAFFOOR, M.D., is Attending Physician, Pediatric Special Care Unit, Maimonides Medical Center, Brooklyn, NY. VINAY VAIDYA, M.D., is Chief Medical Information Officer, Phoenix Children’s Hospital, Phoenix, AZ.

Address correspondence to Dr. Hilmas at the Department of Pharmacy GF-30, Alfred I. duPont Hospital for Children, 1600 Rockland Road, Wilmington, DE 19803 (ehilmas{at}nemours.org).


Purpose. The development, implementation, and evaluation of a comprehensive pediatric medication management system based on computerized orders with standardized concentrations for pediatric continuous infusions are described.

Summary. To attain the Joint Commission mandate of using a few standardized concentrations for pediatric continuous infusion medications, a multidisciplinary team at the University of Maryland Medical Center pediatric intensive care unit restructured the medication management of continuous infusions from the handwritten rule-of-6 method to computerized orders with standardized concentrations. Development of the new system required creating a mathematical algorithm to automatically produce two to four standardized concentrations for 39 continuous infusion medications used in pediatrics, incorporating mnemonics that represent standard drug concentrations into the pharmacy medication-processing system, designing a computerized provider-order-entry program, and introducting smart infusion pumps that were programmed with standardized concentrations. System creation and implementation were completed hospitalwide over 16 months. The system successfully determined two to four standardized concentrations for each continuous infusion medication and allowed application of consistent dose, weight, and fluid restrictions when determining standardized concentrations. Preimplementation and postimplementation evaluation revealed that the new system eliminated several types of medication errors and was well received by all health care team members in pediatrics units.

Conclusion. A technology-based, scientific, comprehensive yet simplified solution to attain the Joint Commission mandate concerning standardized concentrations was developed, implemented, and evaluated. The system successfully determined a limited number of concentrations for each continuous infusion medication for pediatrics and improved safety by eliminating medication errors when delivering these medications.

Index terms: Computers; Concentration; Devices; Drug administration systems; Errors, medication; Hospitals; Injections; Medication orders; Methodology; Pediatrics; Protocols; Technology

 

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