title: Sterile product compounding using an i.v. compounding workflow management system at a pediatric hospital.
abstract: OBJECTIVE
  Patient safety enhancements achieved through the use of an automated i.v. compounding workflow management system are reported.
  
  
  CONCLUSIONS
  Automated systems integrating barcode verification of ingredients and the capture of serial images of all steps of the admixture process have the potential to improve the accuracy of parenteral i.v. medication dose preparation. About 18 months after the implementation of such a system at a large pediatric hospital, a retrospective analysis of dose preparation outcomes was conducted to evaluate the effectiveness of the i.v. workflow manager in detecting compounding errors and to categorize detected errors. In verifying the accuracy of 425,683 medication doses prepared during the approximately 13-month evaluation period, dispensing pharmacists detected preparation or documentation errors affecting 2,900 doses (0.68%); 1,223 of those doses (0.29%) required reworking, and 1,677 (0.4%) were rejected and destroyed. Roughly 23% of the detected errors were classified as undetectable via the pharmacy's previous verification practices, with 167 errors judged to pose the potential for adverse drug events resulting in moderate (n=146) or severe (n=21) harm. Among the reworked and rejected doses, 43.8% and 31.3%, respectively, were due to newly emergent problems not seen with traditional paper-based verification systems; however, most of these errors involved blurry or missing images and were not judged to be clinically significant.
  
  
  CONCLUSIONS
  Implementation of an i.v. workflow management system that integrates barcode verification, automated calculations, and image-capture capabilities led to increased detection of errors in the sterile product compounding process.
authors.affiliation: Thomas T. Moniz, Pharm.D., is Informatics Pharmacist, Department of Pharmacy, Boston Children's Hospital, Boston, MA. Stephen Chu, Pharm.D., is Clinical Pediatric Pharmacist, Department of Pharmacy, Boston Children's Hospital, and Adjunct Professor, MCPHS University School of Pharmacy-Boston. Crystal Tom, Pharm.D., BCPS, is General Pediatrics Pharmacist Team Lead, Department of Pharmacy, Boston Children's Hospital, and Adjunct Professor, Bouvé College of Health Sciences School of Pharmacy, Northeastern University, Boston, and MCPHS University School of Pharmacy-Boston. Peter Lutz, Pharm.D., is Associate Director of Pharmacy, Department of Pharmacy, Boston Children's Hospital, and Adjunct Professor, Bouvé College of Health Sciences School of Pharmacy, Northeastern University, and MCPHS University School of Pharmacy-Boston. Alana Arnold, Pharm.D., BCPS, AQ-ID, is Associate Director of Pharmacy, Boston Children's Hospital, and Adjunct Professor, Bouvé College of Health Sciences School of Pharmacy, Northeastern University, and MCPHS University School of Pharmacy-Boston. Kathleen M. Gura, Pharm.D., BCNSP, FASHP, FPPAG, is Team Leader, Surgical Program, and Clinical Pharmacy Specialist in Gastroenterology/Nutrition, Boston Children's Hospital, and Adjunct Professor, Bouvé College of Health Sciences School of Pharmacy, Northeastern University, and MCPHS University School of Pharmacy-Boston. Al Patterson, Pharm.D., is Director of Pharmacy, Boston Children's Hospital, and Adjunct Professor, Bouvé College of Health Sciences School of Pharmacy, Northeastern University, and MCPHS University School of Pharmacy-Boston. thomas.moniz@childrens.harvard.edu.
authors.forename: Thomas T
authors.initials: TT
authors.lastname: Moniz
authors.affiliation: Thomas T. Moniz, Pharm.D., is Informatics Pharmacist, Department of Pharmacy, Boston Children's Hospital, Boston, MA. Stephen Chu, Pharm.D., is Clinical Pediatric Pharmacist, Department of Pharmacy, Boston Children's Hospital, and Adjunct Professor, MCPHS University School of Pharmacy-Boston. Crystal Tom, Pharm.D., BCPS, is General Pediatrics Pharmacist Team Lead, Department of Pharmacy, Boston Children's Hospital, and Adjunct Professor, Bouvé College of Health Sciences School of Pharmacy, Northeastern University, Boston, and MCPHS University School of Pharmacy-Boston. Peter Lutz, Pharm.D., is Associate Director of Pharmacy, Department of Pharmacy, Boston Children's Hospital, and Adjunct Professor, Bouvé College of Health Sciences School of Pharmacy, Northeastern University, and MCPHS University School of Pharmacy-Boston. Alana Arnold, Pharm.D., BCPS, AQ-ID, is Associate Director of Pharmacy, Boston Children's Hospital, and Adjunct Professor, Bouvé College of Health Sciences School of Pharmacy, Northeastern University, and MCPHS University School of Pharmacy-Boston. Kathleen M. Gura, Pharm.D., BCNSP, FASHP, FPPAG, is Team Leader, Surgical Program, and Clinical Pharmacy Specialist in Gastroenterology/Nutrition, Boston Children's Hospital, and Adjunct Professor, Bouvé College of Health Sciences School of Pharmacy, Northeastern University, and MCPHS University School of Pharmacy-Boston. Al Patterson, Pharm.D., is Director of Pharmacy, Boston Children's Hospital, and Adjunct Professor, Bouvé College of Health Sciences School of Pharmacy, Northeastern University, and MCPHS University School of Pharmacy-Boston.
authors.forename: Stephen
authors.initials: S
authors.lastname: Chu
authors.affiliation: Thomas T. Moniz, Pharm.D., is Informatics Pharmacist, Department of Pharmacy, Boston Children's Hospital, Boston, MA. Stephen Chu, Pharm.D., is Clinical Pediatric Pharmacist, Department of Pharmacy, Boston Children's Hospital, and Adjunct Professor, MCPHS University School of Pharmacy-Boston. Crystal Tom, Pharm.D., BCPS, is General Pediatrics Pharmacist Team Lead, Department of Pharmacy, Boston Children's Hospital, and Adjunct Professor, Bouvé College of Health Sciences School of Pharmacy, Northeastern University, Boston, and MCPHS University School of Pharmacy-Boston. Peter Lutz, Pharm.D., is Associate Director of Pharmacy, Department of Pharmacy, Boston Children's Hospital, and Adjunct Professor, Bouvé College of Health Sciences School of Pharmacy, Northeastern University, and MCPHS University School of Pharmacy-Boston. Alana Arnold, Pharm.D., BCPS, AQ-ID, is Associate Director of Pharmacy, Boston Children's Hospital, and Adjunct Professor, Bouvé College of Health Sciences School of Pharmacy, Northeastern University, and MCPHS University School of Pharmacy-Boston. Kathleen M. Gura, Pharm.D., BCNSP, FASHP, FPPAG, is Team Leader, Surgical Program, and Clinical Pharmacy Specialist in Gastroenterology/Nutrition, Boston Children's Hospital, and Adjunct Professor, Bouvé College of Health Sciences School of Pharmacy, Northeastern University, and MCPHS University School of Pharmacy-Boston. Al Patterson, Pharm.D., is Director of Pharmacy, Boston Children's Hospital, and Adjunct Professor, Bouvé College of Health Sciences School of Pharmacy, Northeastern University, and MCPHS University School of Pharmacy-Boston.
authors.forename: Crystal
authors.initials: C
authors.lastname: Tom
authors.affiliation: Thomas T. Moniz, Pharm.D., is Informatics Pharmacist, Department of Pharmacy, Boston Children's Hospital, Boston, MA. Stephen Chu, Pharm.D., is Clinical Pediatric Pharmacist, Department of Pharmacy, Boston Children's Hospital, and Adjunct Professor, MCPHS University School of Pharmacy-Boston. Crystal Tom, Pharm.D., BCPS, is General Pediatrics Pharmacist Team Lead, Department of Pharmacy, Boston Children's Hospital, and Adjunct Professor, Bouvé College of Health Sciences School of Pharmacy, Northeastern University, Boston, and MCPHS University School of Pharmacy-Boston. Peter Lutz, Pharm.D., is Associate Director of Pharmacy, Department of Pharmacy, Boston Children's Hospital, and Adjunct Professor, Bouvé College of Health Sciences School of Pharmacy, Northeastern University, and MCPHS University School of Pharmacy-Boston. Alana Arnold, Pharm.D., BCPS, AQ-ID, is Associate Director of Pharmacy, Boston Children's Hospital, and Adjunct Professor, Bouvé College of Health Sciences School of Pharmacy, Northeastern University, and MCPHS University School of Pharmacy-Boston. Kathleen M. Gura, Pharm.D., BCNSP, FASHP, FPPAG, is Team Leader, Surgical Program, and Clinical Pharmacy Specialist in Gastroenterology/Nutrition, Boston Children's Hospital, and Adjunct Professor, Bouvé College of Health Sciences School of Pharmacy, Northeastern University, and MCPHS University School of Pharmacy-Boston. Al Patterson, Pharm.D., is Director of Pharmacy, Boston Children's Hospital, and Adjunct Professor, Bouvé College of Health Sciences School of Pharmacy, Northeastern University, and MCPHS University School of Pharmacy-Boston.
authors.forename: Peter
authors.initials: P
authors.lastname: Lutz
authors.affiliation: Thomas T. Moniz, Pharm.D., is Informatics Pharmacist, Department of Pharmacy, Boston Children's Hospital, Boston, MA. Stephen Chu, Pharm.D., is Clinical Pediatric Pharmacist, Department of Pharmacy, Boston Children's Hospital, and Adjunct Professor, MCPHS University School of Pharmacy-Boston. Crystal Tom, Pharm.D., BCPS, is General Pediatrics Pharmacist Team Lead, Department of Pharmacy, Boston Children's Hospital, and Adjunct Professor, Bouvé College of Health Sciences School of Pharmacy, Northeastern University, Boston, and MCPHS University School of Pharmacy-Boston. Peter Lutz, Pharm.D., is Associate Director of Pharmacy, Department of Pharmacy, Boston Children's Hospital, and Adjunct Professor, Bouvé College of Health Sciences School of Pharmacy, Northeastern University, and MCPHS University School of Pharmacy-Boston. Alana Arnold, Pharm.D., BCPS, AQ-ID, is Associate Director of Pharmacy, Boston Children's Hospital, and Adjunct Professor, Bouvé College of Health Sciences School of Pharmacy, Northeastern University, and MCPHS University School of Pharmacy-Boston. Kathleen M. Gura, Pharm.D., BCNSP, FASHP, FPPAG, is Team Leader, Surgical Program, and Clinical Pharmacy Specialist in Gastroenterology/Nutrition, Boston Children's Hospital, and Adjunct Professor, Bouvé College of Health Sciences School of Pharmacy, Northeastern University, and MCPHS University School of Pharmacy-Boston. Al Patterson, Pharm.D., is Director of Pharmacy, Boston Children's Hospital, and Adjunct Professor, Bouvé College of Health Sciences School of Pharmacy, Northeastern University, and MCPHS University School of Pharmacy-Boston.
authors.forename: Alana
authors.initials: A
authors.lastname: Arnold
authors.affiliation: Thomas T. Moniz, Pharm.D., is Informatics Pharmacist, Department of Pharmacy, Boston Children's Hospital, Boston, MA. Stephen Chu, Pharm.D., is Clinical Pediatric Pharmacist, Department of Pharmacy, Boston Children's Hospital, and Adjunct Professor, MCPHS University School of Pharmacy-Boston. Crystal Tom, Pharm.D., BCPS, is General Pediatrics Pharmacist Team Lead, Department of Pharmacy, Boston Children's Hospital, and Adjunct Professor, Bouvé College of Health Sciences School of Pharmacy, Northeastern University, Boston, and MCPHS University School of Pharmacy-Boston. Peter Lutz, Pharm.D., is Associate Director of Pharmacy, Department of Pharmacy, Boston Children's Hospital, and Adjunct Professor, Bouvé College of Health Sciences School of Pharmacy, Northeastern University, and MCPHS University School of Pharmacy-Boston. Alana Arnold, Pharm.D., BCPS, AQ-ID, is Associate Director of Pharmacy, Boston Children's Hospital, and Adjunct Professor, Bouvé College of Health Sciences School of Pharmacy, Northeastern University, and MCPHS University School of Pharmacy-Boston. Kathleen M. Gura, Pharm.D., BCNSP, FASHP, FPPAG, is Team Leader, Surgical Program, and Clinical Pharmacy Specialist in Gastroenterology/Nutrition, Boston Children's Hospital, and Adjunct Professor, Bouvé College of Health Sciences School of Pharmacy, Northeastern University, and MCPHS University School of Pharmacy-Boston. Al Patterson, Pharm.D., is Director of Pharmacy, Boston Children's Hospital, and Adjunct Professor, Bouvé College of Health Sciences School of Pharmacy, Northeastern University, and MCPHS University School of Pharmacy-Boston.
authors.forename: Kathleen M
authors.initials: KM
authors.lastname: Gura
authors.affiliation: Thomas T. Moniz, Pharm.D., is Informatics Pharmacist, Department of Pharmacy, Boston Children's Hospital, Boston, MA. Stephen Chu, Pharm.D., is Clinical Pediatric Pharmacist, Department of Pharmacy, Boston Children's Hospital, and Adjunct Professor, MCPHS University School of Pharmacy-Boston. Crystal Tom, Pharm.D., BCPS, is General Pediatrics Pharmacist Team Lead, Department of Pharmacy, Boston Children's Hospital, and Adjunct Professor, Bouvé College of Health Sciences School of Pharmacy, Northeastern University, Boston, and MCPHS University School of Pharmacy-Boston. Peter Lutz, Pharm.D., is Associate Director of Pharmacy, Department of Pharmacy, Boston Children's Hospital, and Adjunct Professor, Bouvé College of Health Sciences School of Pharmacy, Northeastern University, and MCPHS University School of Pharmacy-Boston. Alana Arnold, Pharm.D., BCPS, AQ-ID, is Associate Director of Pharmacy, Boston Children's Hospital, and Adjunct Professor, Bouvé College of Health Sciences School of Pharmacy, Northeastern University, and MCPHS University School of Pharmacy-Boston. Kathleen M. Gura, Pharm.D., BCNSP, FASHP, FPPAG, is Team Leader, Surgical Program, and Clinical Pharmacy Specialist in Gastroenterology/Nutrition, Boston Children's Hospital, and Adjunct Professor, Bouvé College of Health Sciences School of Pharmacy, Northeastern University, and MCPHS University School of Pharmacy-Boston. Al Patterson, Pharm.D., is Director of Pharmacy, Boston Children's Hospital, and Adjunct Professor, Bouvé College of Health Sciences School of Pharmacy, Northeastern University, and MCPHS University School of Pharmacy-Boston.
authors.forename: Al
authors.initials: A
authors.lastname: Patterson
mesh_terms: D061605:Administration, Intravenous; D001331:Automation; D004339:Drug Compounding / Q000379:methods*; D001330:Electronic Data Processing; D006776:Hospitals, Pediatric / Q000458:organization & administration*; D006801:Humans; D019300:Medical Errors / Q000517:prevention & control; D008508:Medication Errors / Q000517:prevention & control; D061214:Patient Safety; D010607:Pharmacy Service, Hospital / Q000458:organization & administration*; D015397:Program Evaluation; D012189:Retrospective Studies; D013242:Sterilization / Q000379:methods*; D057188:Workflow