C3.2 R3: Prepare and dispense medications according to organizational policies and procedures

ID: 45 weeks + 3 days (post-menstrual age) 4.9kg female (considered paediatrics) with Klebsiella bacteremia

  • Microbiologist recommended cefotaxime IV for coverage and the pediatrician wanted to use the meningitis dose
  • Order was written for cefotaxime 375mg IV Q6H

For all neonatal + pediatric medications, pharmacists have to check the dose

  • As per C&W online formulary and progress notes, the dose is appropriate

In order to select the correct set (LK-), it is important to refer to the pediatric PDTM (45 wks post-menstrual [gestational age + chronological age] to 17yo). The Alaris Pump has a drug library based on the PDTM, with different profiles such as Adult, Critical Care, Maternity, etc.

Screen Shot 2017-01-18 at 11.21.47 PM.png

  • Dose is < 920mg – therefore, it would be in a syringe
    → selected kit: Peds Cefotaxime IV 40mg/mL (up to 920mg)

 

For the Alaris pump, there needs to be a minimum of 2mL extra to prime the line. When the syringe is programmed for the dose, it will prime the line and then only dispense the volume of drug ordered (any remaining volume in the syringe will be discarded).

  • syringes can only be drawn up to 75% of maximum volume
  • when entering the order, select the smallest appropriate size syringe
    → volume of drug + priming required ~ 11mL → syringe: 20mL

After the order is verified, it proceeds to the filling station where 4 labels are printed out (for 4 syringes) and goes to be made.

For pediatric orders, there are “recipe” sets that the IV tech has to follow when mixing:

  • For this order, the cefotaxime 1g vial (200mg/mL) has to be diluted to 40mg/mL and the recipe provides steps on how to do that

The following policy has to be followed for compounding sterile preparations: compounded-sterile-preps-aseptic-technique. Prior to going in the IV room, the IV tech alcohol wipes all the supplies (syringes, vials, etc.) and places it in an alcohol-wiped bin. This bin is placed in a designated sterile area near the window into the IV mixing room.

I was able to follow the IV tech into the mixing room, and had to follow the garbing procedure as FH policy: garbing-poster. After wearing all the protective equipment, we step over to the “clean” area where the laminar hood and extra mixing supplies are kept and are not able to step back into the ante room unless we are planning to de-garb. The laminar hood needs to be alcohol-wiped prior to mixing. As well, all the hard or plastic supplies placed into the laminar hood have to be alcohol-wiped and mixing occurs 6 inches into the laminar hood where it is considered sterile. It is important to avoid blocking the air flow (flowing from the back of the hood towards the mixer) from the product to ensure sterility, as well as, to avoid contacting critical sites (like the syringe plunger). 2 really cool things in the LMH IV room was that there was a “product/vial-shaking” machine and an intercom for techs to use if they needed supplies from outside! 😮 Some things to keep in mind when mixing are that the expiry date on vials are actually “best used” dates – so even if a drug was expiring today, as long as it was reconstituted and injected into the bag, the stability of the full product is extended to the stated expiry of the stability chart – an example: civa-recon-and-stability-chart-adult-aug-2014, as well as, that all syringes are only good for 24 hours after mixing. So for this order, we mixed 4 luer-locked syringes which will help cover the next 24 hours. The preparations are wiped and passed back to the IV prep room through the window to be checked. After exiting the IV room, IV tech wear a white coat to protect their environment from their contaminated scrubs.

Useful resources: