Reduction in Variation of Intravenous Drug Administration in Seventeen San Diego Hospitals With Standardized Drug Concentrations and Dosage Units
Eastham, J.H., Rizos, A., Gama, J.A., Geriak, M., Howard, J.J., Johnson, S.J., Low, C.C., Page, D., Schultz, D., Tallian, K.B., Richter, R., Quicci-Roberts, K.E., Vanderveen, T.W. & Pratt, N.G. (February 2009). Hospital Pharmacy, 44: 2, 150–158 Wolters Kluwer Health, Inc.
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Abstract
Purpose: To standardize intravenous (IV) medication concentrations and dosage units across adult hospitals in San Diego County.
Methods: The San Diego Patient Safety Consortium Task Force comprised representatives from 17 adult hospitals. The first step was a survey of concentration standards and dosage units for the most common and highest-risk IV medications in use at all sites. Survey results were compared with manufacturers’ recommendations and reference materials. A Delphi decision-making process was used to determine final drug concentration and dosage units for each drug.
Results: Survey results showed more than 85 concentrations used for 34 drugs. Nine of these were high-risk medications, for which 27 different concentrations were identified. With the exception of magnesium sulfate for non-obstetric use, a single concentration was developed for each medication, resulting in a greater than 94% reduction in variation from concentration standards. A single concentration standard was developed for each high-risk medication, resulting in a 77% reduction in variation. A single dosage unit standard was developed for all medications reviewed, resulting in a 100% reduction in variation. Of the 17 hospitals, 15 were assessed for adoption of the standards. Of these 15 hospitals, adoption of concentrations standards ranged from 72.2% to 100% and adoption of dosage units ranged from 84.8% to 100%.
Conclusion: Countywide standardization of high-risk IV drug concentrations and dosage units reduces variability in IV therapy, which can help promote safer and more consistent practices in IV medication administration. It is expected that standardization will decrease the potential for medication errors within hospitals and on patient transfer to other healthcare facilities.