title: Evaluation of an intravenous preparation information system for improving the reconstitution and dilution process.
abstract: There are very few studies reporting the impact of providing intravenous (IV) preparation information on quality use of antimicrobials, particularly regarding their reconstitution and dilution. Therefore, to improve these processes in IV antimicrobial administration, an IV preparation information system (IPIS) was implemented in a hospital.
  
  
  
  We aimed to evaluate the effect of improving reconstitution and dilution by implementing an IPIS in the electronic medical record (EMR) system.
  
  
  
  Prescriptions and activity records of nurses for injectable antimicrobials that required reconstitution and dilution for IV preparation from January 2008 to December 2013 were retrieved from EMR, and assessed based on packaging label information for reconstituting and diluting solutions. We defined proper reconstitution and dilution as occurring when the reconstitution and dilution solutions prescribed were consistent with the nurses' acting records. The types of intervention in the IPIS were as follows: a pop-up alert for proper reconstitution and passive guidance for proper dilution. We calculated the monthly proper reconstitution rate (PRR) and proper dilution rate (PDR) and evaluated the changes in these rates and trends using interrupted time series analyses.
  
  
  
  Prior to the initiation of the reconstitution alert and dilution information, the PRR and PDR were 12.7 and 46.1%, respectively. The reconstitution alert of the IPIS rapidly increased the PRR by 41% (p<0.001), after which the PRR decreased by 0.9% (p=0.013) per month after several months. However, there was no significant change in the rate or trend of the PDR during the study period.
  
  
  
  This study demonstrated that the provision of reconstitution alerts by the IPIS contributed to improving the reconstitution process of IV antimicrobial injection administration. However, providing passive information on dilution solutions was ineffective. Furthermore, solutions to ensure the continuous effectiveness of alert systems are warranted and should be actively sought.
authors: College of Pharmacy and Research Institute of Pharmaceutical Sciences, Seoul National University, 103 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea; Department of Pharmacy, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea. Electronic address: jobright@snuh.org.
authors: Yun Hee
authors: YH
authors: Jo
authors: College of Pharmacy and Research Institute of Pharmaceutical Sciences, Seoul National University, 103 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea. Electronic address: wgshin@snu.ac.kr.
authors: Wan Gyoon
authors: WG
authors: Shin
authors: College of Pharmacy, Institute of Pharmaceutical Science and Technology, Hanyang University, Ansan 15588, Republic of Korea. Electronic address: jypharm@hanyang.ac.kr.
authors: Ju-Yeun
authors: JY
authors: Lee
authors: Division of Clinical Epidemiology, Medical Research Collaborating Center, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea. Electronic address: bebe77@snu.ac.kr.
authors: Bo Ram
authors: BR
authors: Yang
authors: College of Pharmacy and Research Institute of Pharmaceutical Sciences, Seoul National University, 103 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea. Electronic address: yupharm@snu.ac.kr.
authors: Yun Mi
authors: YM
authors: Yu
authors: Department of Pharmacy, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea. Electronic address: shoijung@snuh.org.
authors: Sun Hoi
authors: SH
authors: Jung
authors: Department of Pharmacy, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea. Electronic address: hyangsook0716@hanmail.net.
authors: Hyang Sook
authors: HS
authors: Kim
mesh_terms: D061605:Administration, Intravenous; D020000:Decision Support Systems, Clinical; D004339:Drug Compounding; D057286:Electronic Health Records; D006801:Humans; D009726:Nurses; D009737:Nursing Records
keywords: Electronic medical record; Interrupted time series analysis; Intravenous preparation information system; Proper dilution rate; Proper reconstitution rate