Advocates for Safe IV Preparation Practices Share Their Inspiration Podcast

Mark Neuenschwander
Founding Director, THRIVCoalition.org

Seminal research from 1997 on IV compounding discovered that 9 percent of manually compounded sterile preparations had incorrect ingredients and/or volumes. While a study from two decades ago may no longer seem relevant, the fact is, the vast majority of today’s IVs are still being prepared through error-prone manual processes.

This prompted our founding of THRIV, a safety coalition comprised of healthcare providers, consumers, and technology leaders, to help protect patients from harm that too often stems from mistakes made when IVs are manually prepared.

Unarguably, the safest-to-use IV medications are those arriving at bedsides in ready-to-administer (RTA) formulations that have not been manipulated between drug manufacturer production lines and drug lines dripping into patients.

Unfortunately, many formularies for RTA products are limited by personalized dosing requirements, especially among the pediatric population and increasingly with the demand for DNA-informed tailored dosing. And this doesn’t even take into account the manual involvement associated with the stream of new drugs coming to market. All this means hospitals must prepare the majority of their IVs in-house and, we believe this will continue.

In fact, in a 2020 ISMP Sterile Compounding Pulse Check conducted with 634 pharmacy practitioners, only 25% of respondents report using technologies that include barcode verification, images, and gravimetric verification for 50% of compounded sterile products. Worst yet, 74% of all respondents were aware of at least one pharmacy compounding error in the last 12 months.

Fortunately, this is where THRIV comes to play. Our coalition is focused on championing the universal use of automated IV workflow management systems in compounding pharmacies.

At THRIV, we’ve developed a Technology Checklist that outlines criteria that IV Workflow Systems must meet or exceed:

• Workflow Management Software that guides compounders and/or robotics safely through the step-by-step recipe for each dose with forcing functions that won’t allow proceeding to next steps until previous steps have been completed and verified.

• Barcode Scanning to verify that each component and ingredient is correct.

• Volume Verification that ensure base solutions and additives are correct, (e.g., image capture, gravimetrics,   flowmetrics and/or optical volume recognition.

• Auto Bar-Code Labeling produced only for final preparations.

• Auto Documentation timestamps each preparation step serving as a black box and assists in fulfilling USP documentation requirements.

While we are all about protecting patients, we at THRIV are equally concerned about protecting caregivers. The Nightingale Nursing Pledge affirms: “I shall not knowingly administer any harmful drug.” But every day, nurses are administering medications and IVs that they may not realize could be harmful. Take the case of a nurse at Seattle Children’s who had 25 years of exemplary service in caring for infants, yet accidentally overdosed a baby with sodium chloride, and the baby died. Three months later the nurse took her own life.

THRIV is advocating for the day when IV workflow technologies are required by regulatory, accrediting, and grading bodies. In the meantime, we appeal that all who prepare IVs, voluntarily leverage automated workflow safety systems for every IV preparation

I hope you will join Derek Gillespie, BPharm, MBA, Pharmacy Operations Manager at Renown Health and me, along with host Ken Perez, Vice President of Healthcare Policy at Omnicell, for the next episode of The Future of Pharmacy Podcast. We’ll be sharing our insights into this crucial topic and sharing our experiences in one of the highest risk areas of pharmacy.

For 25+ years, Mark Neuenschwander has been advocating for wise development and sound deployment of medication-safety technologies.His was a leading voice in persuading the FDA to require bar codes on all immediate drug containers. He is the tenth recipient of the Institute for Safe Medication Practices’ Lifetime Achievement Award. Today, he extends his influence as founding director of THRIV—a patient-safety coalition advocating for accuracy in IV preparation.

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The views and opinions expressed in this blog are those of the authors and do not necessarily reflect the official policy or position of any other agency, organization, employer or company. Assumptions made in the analysis are not reflective of the position of any entity other than the author(s). These views are always subject to change, revision, and rethinking at any time and may not be held in perpetuity.