Standardized Medication Concentrations for Parenteral Infusion

Medication Management:

Revised: February 19, 2014

• Medication Management• Background

• Provincial Parenteral Manual• Roll-out & Transition• Access & Support

• Standardized Medication Concentrations (SMCs)• SMC Lists & Policy• What you need to do• Next Steps

Agenda

Collaborative approach to prevent and minimize medication errors and near misses to increase patient safety

Addresses all medication aspects from prescription, selection, preparation, and dispensing to the administering of medication and ongoing monitoring of patients

Medication Management

Medication Concentration

Narcotics Safety

Heparin Safety

Antimicrobial Stewardship

Others?

Concentrated Electrolytes

High Alert Medication

Medication Reconciliation

Structures

ProcessesPrinciples

Strategies

Education and Training

Policies

Mission Vision Values

Medication Management

The new Provincial Parenteral Monographs provides:

• Single common parenteral monograph throughout the province

• Ensures patient safety and consistent medication administration and management

• Electronic reference for drug therapy guidelines and parenteral drug information

• Provincial Parenteral Manual - Link

• Although PPM can be access electronically, a hard copy must be maintained for downtime instances

Provincial Parenteral Monographs (PPM)

NOTE: The new Provincial Parenteral Monographs are NOT a comprehensive drug reference – if further information

required, please consult other sources (i.e. Drug Information Services)

• Ongoing roll-out of the new PPM will take place as therapeutic drug classes are completed

• Use existing site specific monographs until new provincial monograph is available

Provincial Parenteral Monographs (PPM)

Parenteral Manual (top blue bar)

New Provincial Parenteral

MonographsOld legacy

sites will link to new AHS monographs

CompassionNet (homepage)

AHS Provincial Parenteral Manual

(InSite page)

Use existing old legacy parenteral

monographs

No new monograph updated

Click Here

Click Here

What are SMCs:

• Medication infusions which are mixed according to a limited number of pre-determined drug concentrations

• Focused on high alert medications

• Established based on stakeholder input, focusing on the Institute for Safe Medication Practices’ (ISMP) list of high-alert medications

• Took into account: legacy lists, parenteral drug monographs, stakeholder feedback, leading practices, availability from manufacturer, and concentrations implemented at other sites within Canada & USA

Standardized MedicationConcentrations (SMCs)

Two (2) NEW Standardized Medication Concentration Lists:

Adult Standardized Medication Concentration List:• Currently, a total of 50 drugs with 104 concentrations

Neonatal Standardized Medication Concentration List:

*** April 1st: begin smart pump software upgrade & drug libraries updates

*** Revise pre-printed patient care orders and mixing sheets based on new Standardized Medication Concentrations List

Standardized MedicationConcentrations (SMCs)

Adobe Acrobat Document

Adobe Acrobat Document

NOTE: Roll-out for Insulin and Vasopressin will need to be deferred

Why SMC Lists?

• Safety• Minimizing medication errors to ensure patient safety

Decreasing number of concentration and volume options available for the same medication reduces the risk that a healthcare provider will select, dispense, or administer the wrong concentration

• Standardization and Consistency• Reduce the number of steps and processes and the reliance on

human memory and vigilance

• Compliance• Accreditation Canada’s Medication Management ROP 2.5 – Major

Test for Compliance:

“The orgnizational limits and standardizes concentrations and volume options available for high-alert medications”

Standardized MedicationConcentrations (SMCs)

Facts:

• Medication errors are the LARGEST identified source of preventable hospital medical errors

• Parenteral Administration errors are three (3) times as likely to cause harm or death compared with other errors

• 79% of reported harmful or fatal medication errors involve the IV route

• 58% of these errors occurred during administration of the medication

• Healthcare expenses due to preventable errors cost Canadians $750 million/year

• A hospital patient can expect to be subjected to more than one (1) medication error a day (Institute of Medicine 2006)

Standardized MedicationConcentrations (SMCs)

Errors in the Medication Use Process:

Standardized MedicationConcentrations (SMCs)

Facts:

• We are Human – Humans are Fallible!• Sometimes, we make mistakes, no matter how familiar we are

• We must design our work processes to help us reduce the possibility of mistakes/errors and ensure that mistakes/errors are detected and corrected.

Standardized MedicationConcentrations (SMCs)

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Standardized MedicationConcentrations (SMCs)

Policy & Procedure:

Ordering Medications• Concentrations may or may not be part of the order

• If ordering a non-SMC, must document clinical reason why and indicate clearly the preferred medication concentration

Processing Medication Orders• Concentrations to be clarified by a Health Care Professional and

documented as per site processes on chart

Standardized MedicationConcentrations (SMCs)

Policy & Procedure:

Preparing Medications• Use ready-to –administer format whenever/wherever possible

• Use parenteral monographs for mixing instructions

Labels & Instructions

Standard Concentrations • No label required

High Concentrations

Non-Standardized Concentrations

IDC on calculations & preparation

+

Standardized MedicationConcentrations (SMCs)

Policy & Procedure:

Administering Medications• Utilize smart pump drug libraries

• If non-SMC are used, manual programming of the pump is required with verification via an IDC

Auditing• Pharmacy to audit compliance by reviewing: infusions dispensed,

medication orders, MARs, and/or patient charts

• Nursing to audit compliance using data from: smart pumps, MARs, and/or patient charts

Standardized MedicationConcentrations (SMCs)

What do you need to do?

Nursing• CNEs to notify staff on new SMCs and how to how to mix and

handle orders (either with no specified SMCs, or with non-SMC specified)

• Identify sources required: mixing sheets, pocket cards, posters, etc.

• Units to ensure appropriate drug supply in areas of med storage not supplied by Pharmacy (i.e. crash carts)

• Ensure smart pumps have version 12 drug library after April 1st

• Audit compliance with SMCs (i.e. data from smart pumps, using MARs and/or patient profiles/charts)

Standardized MedicationConcentrations (SMCs)

What do you need to do?

Pharmacy• Amend pharmacy computer system to reflect new SMCs

• Update stock in pharmacy and on nursing units if needed

• Update wardstock lists

• Purchase or make products whenever possible

• Update sterile manufacturing worksheets for IV room if needed

• Train staff on how to handle orders (either with no SMC specified, or with the wrong SMC specified)

• Audit compliance with SMCs (i.e. review of orders, infusions dispensed, review of MARs/patient profiles/charts)

Standardized MedicationConcentrations (SMCs)

What do you need to do?

Prescribers• Ensure medication order comply with SMCs when ordering

standardized concentrations (i.e. magnesium sulfate)

• Ensure using SMCs when mixing on own (i.e. anesthetists)

• Specify preferred concentration and clinical reason why SMC will not meet the patient’s needs of want to use and non-SMC

All users of PPCOs• Ensure PPCOs comply with SMCs and revise as needed

What Now?

Communicate

Familiarize & Learn Educate

Lead

March 3-7 March 10-14 March 17-21 March 24-28 March 31-April 4 April 7-11 April 14-18 April 21-25 April 28-May 2 May 5-9

SM

C Im

ple

men

tati

on

April 1, 2014: Smart Pump Drug Library Update &

SMC List Available

RAH

UofA

Staff Training (provided by CNE)

PharmacyTraining

MCH

Training

Smart Pump Upgrade

Legend:

GNCH

Roll-out: April 1st, 2014

For More Information…

• Parenteral Monographshttp://intraweb01.albertahealthservices.ca/Pharmacy/pm_edm/index.asp

• Smart Pump Libraryhttp://www.intranet.capitalhealth.ca/smartivpumps/Reports.htm

• Policy and ProceduresWill be located on CompassionNet once finalized

Questions