Optimizing i.v. workflow

I.V. room workflow systems employ various technologies to verify drugs and doses during sterile compounding. These systems may differ in concept and detail, but all incorporate workflow queues to organize and prioritize doses and compounding instructions in order to standardize preparation. Until the late 1960s, i.v. doses requiring the addition of a drug to an i.v. fluid were commonly prepared by nurses and physicians. These doses were prepared in the nursing unit or surgical suite without cleanrooms or special equipment and with little regard for aseptic technique. This scenario changed in the late 1960s and early 1970s, when sterile compounding became a pharmacy responsibility.1,–4 Hospital pharmacies installed laminar-airflow hoods and incorporated principles of aseptic technique into the preparation of compounded sterile products (CSPs). The most widespread method of preparing and verifying CSPs was, and still is, a manual process entailing much operator variability. In many hospitals, pharmacy technicians prepare CSPs without direct pharmacist supervision and place the completed i.v. dose outside of the sterile compounding area accompanied by the empty vial(s) and syringe(s). The pharmacist then verifies the dose by inspecting the empty drug vial and syringe (with the plunger pulled back to indicate the volume of drug that has been added). This manual process for preparing and verifying CSPs is error prone, since it relies on human vigilance to ensure accuracy. Several fatal i.v.-room mixing errors have been reported in the national news, including a mix-up involving concentrated sodium chloride in Ohio in 2008 and a heparin mixing error in Texas in 2008.5,6