Third Consensus Development Conference on the Safety of Intravenous Drug Delivery Systems—2018

Abstract

Purpose The Third Consensus Conference on the Safety of Intravenous Drug Delivery Systems was convened to evaluate the benefits and risks of available systems and assess ongoing threats to the safety of intravenous drug delivery. Summary The Third Consensus Conference on the Safety of Intravenous Drug Delivery Systems convened in Chicago, Illinois in November 2018. An expert panel of healthcare providers with experience in medication quality and safety, pharmacy and nursing operations, information technology, and/or sterile compounding led the conference. An experienced audience of approximately 30 healthcare leaders provided feedback to the panel via preconference survey and during the conference. Additionally, expert speakers presented on a range of issues, including the effects of drug shortages, the impact of standards and guidelines, and patient and administrator perspectives on the importance of intravenous drug delivery safety. Conclusion At the end of the conference, the expert panel concluded that manufacturer ready-to-use products remain the safest intravenous drug delivery system due to their many benefits and low overall risk profile. The panel identified various ongoing threats to the safety of intravenous drug delivery, with major concerns including the impact of drug shortages and lack of intravenous product standardization. Finally, the panel agreed upon a series of statements designed to advance the safety of intravenous drug delivery in healthcare institutions.

Prevalence and determinants of intravenous admixture preparation errors: A prospective observational study in a university hospital

“…The identified determinants point to factors related to the complexity of preparations and working conditions. Strategies may include increased use of ready-to-administer medication [10,11,16], support from pharmacy staff [11], focused educational programmes [60], or interruption management interventions [57,60]. Especially increased used of ready-to-administer medication, pharmacy or industry manufactured, is very promising [10,11,16], as it has been shown to be cost-effective [16].…”

“…Several strategies have been explored to reduce the number of IAPEs [8,10,11], such as implementing pharmacy-based centralised intravenous admixture services (CIVAS) [11][12][13] or automated preparation systems [11,14,15]. These strategies might be cost-effective by preventing adverse drug events [16], which are associated with substantial costs, ranging from approximately €1000 to €7000 per event [17].…”

Advances in safe insulin infusions

“…A search of publications in the PubMed database from 2018 to 2021 including terms related to the management of diabetes in hospitalized patients, indications for IV insulin, options for IV insulin preparation and delivery, and medication errors associated with high-risk medications, including IV insulin, was undertaken to assess the scope of the problem. 1 , 3 – 8 Expert guidelines for insulin use 9 – 15 and expert consensus recommendations for in-house compounding versus manufacturer preparations of high-risk medications 16 – 29 were reviewed to identify best practices. A recent new option for IV insulin was assessed in the context of best practices.…”

“…Several expert consensus panels as well as the Institute for Safe Medical Practice have assessed the state of different IV medication products and processes. 26 – 29 These expert panels evaluated the relative safety and cost of IV drug delivery systems for parenteral medications. Included in the evaluation were the use of manufacturer-prepared products, pharmacy-based IV admixture systems, point-of-care activated systems, direct IV administration products (IV push), augmented IV push products and volume-control chambers.…”

“…The use of manufacturer-prepared formulations has shown improvement in efficiencies while lessening the burden of evolving compounding regulations and overcoming BUD limitations. 26 – 29 The first FDA-approved, manufacturer-prepared insulin infusion, Myxredlin (Insulin Human in 0.9% Sodium Chloride Injection, trademark of Baxter International Inc., Deerfield, IL 60015, USA), is indicated to improve glycaemic control in adults and paediatric patients with diabetes mellitus. Myxredlin is delivered in a proprietary container – a non-polyvinyl chloride and non-di(2-ethylhexyl) phthalate system – that enables it to be stored at room temperature (25°C) for 30 days or for 24 months if refrigerated (2–8°C), thus overcoming the BUD limitations noted for compounded sterile preparations.…”