A Standardized Approach to Pediatric Parenteral Medication Delivery

Abstract

Delivering medications safely to hospitalized pediatric patients presents a significant challenge. Current JCAHO standards require safe medication practices, including the standardization of parenteral medications and solutions. Our institution convened a pediatric process improvement team (consisting of pharmacists, nurses, physicians, and administrators) to address deficiencies in our medication use process. This article describes the standardized parenteral medication processes that this committee ultimately endorsed. The new system was designed to control, simplify, and standardize each major step in the medication use process, from prescribing through administration. The system involved defining and standardizing prescribing practices, which then allowed for reduced variability and the preplanning of drug preparation and administration processes. To ease transition and simplify implementation, three phases of the process were introduced in a step-by-step manner: phase 1, continuous infusions; phase 2, intermittent IV doses; and phase 3, bulk IV fluids. Time to implementation included 6 months of preparation prior to phases 1 and 2 and approximately another year to phase 3. The standardized pediatric parenteral medication process has resulted in improved patient safety and operational efficiency. It has also eliminated the “Rule of six” method of drug preparation and administration.