Implementation of standardized dosing units for six intravenous medications

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“Possible options to standardize i.v. medications along with their pros and cons were presented for discussion to key providers in all of the intensive care units.” Jung et al (2014).

Reference:

Jung, B., Couldry, R., Wilkinson, S. and Grauer, D. (2014) Implementation of standardized dosing units for i.v. medications. American Journal of Health-System Pharmacy. 71(24), p.2153-2158.

Abstract:

Purpose: The implementation of standardized dosing units for six i.v. medications at an academic medical center is described.

Summary: During the implementation of an electronic health record system at an academic medical center, it was noticed that providers could order some i.v. medications in multiple dosing units, including epinephrine, isoproterenol, midazolam, nitroglycerin, norepinephrine, and phenylephrine. Possible options to standardize i.v. medications along with their pros and cons were presented for discussion to key providers in all of the intensive care units. Once the providers agreed on a solution, the information was presented to the pharmacy and therapeutics committee for final approval. A nursing education plan was created and administered before the standardization of dosing units was implemented. A nursing survey was conducted before and after implementation of dosing-unit standardization to determine the effectiveness of nursing education on compliance with the standardization of the dosing units for the listed medications. The survey was designed to evaluate, when given a choice, what dosing units nurses would use to administer epinephrine, isoproterenol, midazolam, nitroglycerin, norepinephrine, and phenylephrine. The decision was made by the key providers to use weight-based dosing—micrograms per kilograms per minute—to allow for consistency of use of these medications for pediatric and adult patients. Nursing education was completed to ensure that nurses were aware of how to safely administer these medications using the new dosing units.

Conclusion: Dosing-unit standardization for dose-adjustable i.v. infusions can provide improved consistency and decrease the potential for dosing errors when administering epinephrine, isoproterenol, midazolam, nitroglycerin, norepinephrine, and phenylephrine.

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