In addition to the resource referenced in this post, please see and review ISMP Safe Practice Guidelines for Adult IV Push Medications: A compilation of safe practices from the ISMP Adult IV Push Medication Safety Summit. Prepared by the Institute for Safe Medication Practices (ISMP). 2015.
All that follows is from the above outstanding resource.
ADULT CONTINUOUS INFUSION STANDARDS
STANDARDIZE 4 SAFETY INITIATIVE
Standardize 4 Safety is the first national, interprofessional effort to standardize medication concentrations to reduce errors, especially during transitions of care.
These national standards will cover:
• Concentrations and dosing units for intravenous continuous medications for adult patients.
• Concentrations for compounded oral liquid medications.
• Concentrations and dosing units for intravenous continuous medications for pediatric patients.
• Doses for oral liquid medications.
• Concentrations for intravenous intermittent medications.
• Concentrations for PCA and epidural medications.
The Standardize 4 Safety initiative began in 2008 when a multistakeholder IV summit was held to address preventing patient harm and death from intravenous (IV) medication errors. Among the recommendations made by the participants was to establish national standards for IV medications in hospitals including standardized concentrations and dosing. In addition, it was recommended that the national standards be created in collaboration with the Food and Drug Administration (FDA), the pharmaceutical industry, and other stakeholders. Since the summit, establishing standardized concentrations has garnered strong support from ASHP members, the Joint Commission, the Institute for Safe Medical Practices (ISMP), and others. 1 2 3 4 5
In 2015 the FDA, through its Safe Use Initiative, awarded ASHP a grant to develop and implement national standardized concentrations for IV and oral liquid medications. The aims of the grant were to: (1) identify a nationwide expert interprofessional panel consisting of physicians, nurses, and pharmacists; (2) create standards for adult continuous IV
infusions, compounded oral liquid medications, pediatric continuous IV infusions, doses for liquid medications, intravenous intermittent infusions, and PCA and epidural medications; (3) disseminate the standards and assess their adoption.
To Err is Human was published in 1999 and highlighted the harm to patients from healthcare error. In that report, medication errors were stated to be responsible for one of 131 outpatient and one of 854 inpatient deaths.6
Healthcare continues to struggle to eliminate harm
to patients. A systematic review and meta-analysis in 2019 estimated one in 20 patients are exposed to preventable medical harm with the highest incidence of events due to medications. Compounded medications,7 especially those given intravenously, are known to be high risk for error due to added complexity and multiple steps required for determining dosing when ordering, concentrations for preparation andrates of infusion for administering.8 9 Using standardization as a quality improvement tool decreases variation, improves safety, and is thefoundation for using clinical pathways and evidence-based guidelines. Standardization allows providers to manage excessive and unintended variation as they customize care for patients.10