Considerations for Sterile Compounding of Parenteral Products for Pediatric Use: Part 2 PharMEDium Lunch and Learn Series ProCE, Inc. www.ProCE.com 1 Considerations for Sterile Compounding of Parenteral Products for Pediatric Use: Part 2 November 10, 2017 Featured Speaker: Kirsten H. Ohler, PharmD, BCPS, BCPPS Neonatal / Pediatric Clinical Pharmacist Clinical Associate Professor, Pharmacy Practice Program Director, PGY2 Pediatric Pharmacy Residency University of Illinois at Chicago College of Pharmacy LUNCH AND LEARN CE Activity Information & Accreditation ProCE, Inc. (Pharmacist and Tech CE) 1.0 contact hour Funding: This activity is self‐funded through PharMEDium. It is the policy of ProCE, Inc. to ensure balance, independence, objectivity and scientific rigor in all of its continuing education activities. Faculty must disclose to participants the existence of any significant financial interest or any other relationship with the manufacturer of any commercial product(s) discussed in an educational presentation. Dr. Ohler has no relevant commercial and/or financial relationships to disclose. 2
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Considerations for Sterile Compounding of Parenteral Products for Pediatric Use: Part 2PharMEDium Lunch and Learn Series
ProCE, Inc.www.ProCE.com 1
Considerations for Sterile Compounding of Parenteral Products for Pediatric Use: Part 2
November 10, 2017
Featured Speaker: Kirsten H. Ohler, PharmD, BCPS, BCPPSNeonatal / Pediatric Clinical PharmacistClinical Associate Professor, Pharmacy PracticeProgram Director, PGY2 Pediatric Pharmacy ResidencyUniversity of Illinois at Chicago College of Pharmacy
LUNCH AND LEARN
CE Activity Information & Accreditation
ProCE, Inc. (Pharmacist and Tech CE)
1.0 contact hour
Funding: This activity is self‐funded through PharMEDium.
It is the policy of ProCE, Inc. to ensure balance, independence, objectivity and scientific rigor in all of its continuing education activities. Faculty must disclose to participants the existence of any significant financial interest or any other relationship with the manufacturer of any commercial product(s) discussed in an educational presentation. Dr. Ohler has no relevant commercial and/or financial relationships to disclose.
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Considerations for Sterile Compounding of Parenteral Products for Pediatric Use: Part 2PharMEDium Lunch and Learn Series
ProCE, Inc.www.ProCE.com 2
Submission of an online self‐assessment and evaluation is the only way to obtain CE credit for this webinar
Go to www.ProCE.com/PharMEDiumRx
Print your CE Statement online
Live CE Deadline: December 8, 2017
CPE Monitor– CE information automatically uploaded to NABP/CPE Monitor upon
completion of the self‐assessment and evaluation (user must complete the “claim credit” step)
Online Evaluation, Self-Assessmentand CE Credit
Attendance Code
Code will be provided at the end of today’s activityAttendance Code not needed for On‐Demand 3
Ask a Question
Submit your questions to your site manager.
Questions will be answered at the end of the presentation.
Your question. . . ?
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Considerations for Sterile Compounding of Parenteral Products for Pediatric Use: Part 2PharMEDium Lunch and Learn Series
ProCE, Inc.www.ProCE.com 3
Resources
Visit www.ProCE.com/PharMEDiumRx to access:
– Handouts
– Activity information
– Upcoming live webinar dates
– Links to receive CE credit
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Considerations for Sterile Compounding of Parenteral
Products for Pediatric Use: Part 2
Kirsten H. Ohler, PharmD, BCPS, BCPPSClinical Associate Professor, Pharmacy Practice
Clinical Pharmacy Specialist, NICUUniversity of Illinois at Chicago
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Considerations for Sterile Compounding of Parenteral Products for Pediatric Use: Part 2PharMEDium Lunch and Learn Series
ProCE, Inc.www.ProCE.com 4
Disclosure
• The speaker, Kirsten H. Ohler, has no actual or potential conflicts of interest related to the information included in this presentation.
• The practice of off‐label medication use in pediatric patients will be discussed.
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Objectives
At the conclusion of Part 2, participants will be able to:
1. Identify considerations in drug formulation and drug delivery processes specific to the pediatric population.
2. Discuss medication safety issues specific to the pediatric population and potential methods to address them.
3. Describe the role a compounding pharmacy team can have in the care of pediatric patients.
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Considerations for Sterile Compounding of Parenteral Products for Pediatric Use: Part 2PharMEDium Lunch and Learn Series
ProCE, Inc.www.ProCE.com 5
Drug Delivery Process
• Considerations– Availability of a “pediatric friendly” formulation
• Need for multiple concentrations
• Need to make dilutions for measurable volumes
– Availability of appropriate drug delivery device• Measurable rates
• Pediatric‐specific safety features
• Impact of “dead space” in syringe
• Impact of “priming volume” in tubing
• In‐line filters may adsorb drugs
– Risk of catheter occlusion9
Drug Delivery Process
• Considerations
– Methods to manage solution overfill
• Simple admixture – may be used if entire bag to be infused to single patient
• Withdrawal drug volume – may be used if volume of medication to be added is large
• Withdrawal drug & overfill volume – may be used if volume of medication to be added is large
• Empty container – may be used when final concentration of drug must be precise
• Must have defined process with clear labeling
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Considerations for Sterile Compounding of Parenteral Products for Pediatric Use: Part 2PharMEDium Lunch and Learn Series
• Medication errors occur more frequently and with greater severity in children
• Awareness of unique safety concerns is imperative for identifying preventative strategies throughout the drug delivery process
• Get “pediatric smart” and practice in a “just culture”
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Considerations for Sterile Compounding of Parenteral Products for Pediatric Use: Part 2PharMEDium Lunch and Learn Series
ProCE, Inc.www.ProCE.com 18
References• American Academy of Pediatrics, Committee on Drugs and Committee on Hospital Care. Policy
statement: Prevention of medication errors in the pediatric inpatient setting. Pediatrics. 2003;112:431‐6.
• American Academy of Pediatrics, Steering Committee on Quality Improvement and Management and Committee on Hospital Care. Policy statement: Principles of pediatric patient safety: reducing harm due to medical care. Pediatrics. 2011;127:1199‐1210.
• Crowley E, Williams R, Cousins D. Medication errors in children: a descriptive summary of medication error reports submitted to the United States Pharmacopeia. Curr Ther Res. 2001;26:627‐40.
• Fortescue EB, Kaushal R, Landrigan CP, et al. Prioritizing strategies for preventing medication errors and adverse drug events in pediatric inpatients. Pediatrics. 2003;111:722‐9.
• Grissinger M. Understanding and managing intravenous container overfill. P & T. 2016;41:140‐1 & 172.
• Levine SR, Cohen MR, Blanchard N, et al. Guidelines for preventing medication errors in pediatrics. J Pediatr Pharmacol Ther. 2001;6:426‐42.
• Prescott WA, Dahl EM, Hutchinson DJ. Education in pediatrics in US colleges and schools of pharmacy. AJPE. 2014;78:1‐9.
• Rich DS, Fricker Jr. MP, Cohen MR, et al. Guidelines for the safe preparation of sterile compounds: results of the ISMP sterile preparation compounding safety summit of October 2011. Hosp Pharm. 2013;48:382‐94.
• Sherwin CMT, Medlicott NJ, Reith DM, et al. Intravenous drug delivery in neonates: lessons learnt. Arch Dis Child. 2014;99:590‐4.