By Hanna Phan, PharmD
Deborah A. Pasko, PharmD
John F. Mitchell, PharmD
Diane S. Shoemaker, CPhT
Denise K. Glenn, RPh
James G. Stevenson, PharmD

HUMAN ERROR IS INEVITABLE IN ANY PRACTICE OR WORK SETTING. IN dispensing medications, pharmacists typically check technicians’ work to prevent errors. However, even a double check that is 99.9% accurate would allow for 1,000 errors a year in an institution that dispenses one million doses annually. A more reliable method of verifying the validity of final IV products—particularly high-risk medications—is needed.

In many hospitals, a pharmacist checks the components of an IV medication in the hood prior to compounding, and in a post-compounding double check, a second pharmacist verifies that the proper amounts of drug and diluent were combined. However, if multiple preparations are being compounded, that double check, which is based on empty syringes and medication vials, may fail to accurately verify the final product. For example, if the technician inadvertently used the wrong syringe or vial while compounding a particular preparation, particularly if both the drug and diluent are clear in color, the error could be missed by the overseeing pharmacist. Ideally, IV medications should be made one at a time in the hood to avoid such errors, but this practice is often seen as decreasing workflow efficiency and leading to delayed delivery of patient care.

At C.S. Mott Children’s Hospital, a university-based teaching hospital within the University of Michigan Health System located in Ann Arbor, Michigan, we prepare one million pediatric doses annually. Our pharmacy department sought to improve medication safety through added measures to verify compounded, high-risk IV medications. In May 2005, we implemented the ValiMed System by CDEX and developed standard IV concentrations, as part of our two-pronged approach to assuring the safety of high-risk medications.

ValiMed uses ultraviolet (UV) fluorimetry, in conjunction with software and a simple user interface, to verify IV medications and concentrations prior to dispensing, using a 1-mL sample of the preparation. The sample is energized by the UV light source, producing a consistent pattern of fluorescent energy called a signature. Each medication and concentration combination emits its own characteristic signature, and a library of signatures can be created for commonly dispensed concentrations. Our pharmacy’s clinical coordinator developed standard drip concentrations, dependent on age and weight, for selected high-risk IV medications. Using the standard concentrations, we established a library of ValiMed signatures, one for each combination of medication, diluent, and
concentration. Our signature library currently includes:

• epinephrine
• gentamicin
• dobutamine
• lorazepam
• hydromorphone
• vancomycin
• dopamine
• insulin
• morphine

A signature will soon be added for heparin.

Our current process, using ValiMed, is as follows: Once an initial IV order
has been filled in the hood, it is placed on a tray for doublechecking, along with a 1-mL sample (in a ValiMed-compatible cubette). The cubette is then placed in the ValiMed machine, where it is verified against a stored signature. This sample testing, which takes about 30 seconds to complete, has been well received as a manageable addition to our pharmacy’s workflow.

ValiMed has added an important safety check for high-risk IV products at the University of Michigan Health System, performing the critical final check to determine that the correct drug and the correct concentration are present. We have experienced a reduction in major IV-related drug errors since implementing both the ValiMed System and standardized concentrations of high-risk IV medications. Reducing medical errors is a key initiative in our health system, and we believe that ValiMed will improve the accuracy of our IV products.

Hanna Phan, PharmD, is a pediatric pharmacist for C.S. Mott Children’s Hospital and a clinical instructor for the University of Michigan College of Pharmacy.

Deborah A. Pasko, PharmD, serves as the clinical coordinator of the C.S. Mott Children’s Hospital pharmacy, a clinical pharmacy specialist for pediatric intensive care, and an adjunct clinical assistant professor for the University of Michigan College of Pharmacy.

John F. Mitchell, PharmD, FASHP, serves as the medication safety coordinator for the department of pharmacy at C.S. Mott Children’s Hospital and as a clinical associate professor for the University of Michigan College of Pharmacy.

Diane Shoemaker, CPhT, serves as an inpatient pharmacy technical coordinator for the University of Michigan Health System.

Denise Glenn, RPh, is the pharmacy supervisor at C.S. Mott Children’s Hospital.

James G. Stevenson, PharmD, is director of pharmacy services for University of Michigan Hospitals and Health Centers, as well as a professor and associate dean for clinical sciences at University of Michigan College of Pharmacy.