Determining the Need for Standardized Infusions and Concentrations at Hospitals within North Carolina

In 2013, the American Society of Health-System Pharmacists (ASHP) endorsed a policy recommending the development of nationally standardized drug concentrations and dosing units. Although many hospitals have started standardizing their intravenous (IV) solutions, few have taken the practice beyond their institutions or local geographical areas.

This project evaluates the current IV standardization practices for adult patients across hospitals in North Carolina and compares them with each other. In addition, this project proposed standards and evaluated them for their impact on reducing observed variability.

In the fall of 2013, an e-mail request was sent to select hospital pharmacy leaders in North Carolina asking them to voluntarily submit a copy of their adult IV standard concentrations and dosing guidelines. From these lists, the data were summarized and compiled to evaluate trends and compare the various policies.

A total of 18 different hospitals and health systems responded. Survey results showed more than 255 concentrations for 84 unique drugs. Of these, 37 were high-risk medications, with 135 unique drug concentrations. From this list, a single proposed concentration was developed for each medication. If utilized, this standardization would result in a greater than 65% reduction in potential drug concentrations in use. A single dosing unit was also proposed for all medications reviewed, resulting in a greater than 21% reduction in variation.

Standardization of IV drug concentrations and dosing units statewide could reduce the variability in IV therapies and promote safer and more consistent practices in medication administration.