Help Transition to Standard Concentrations for Compounded Oral Liquids

You'll see a push to standardize concentrations for compounded ORAL liquids...to help prevent med errors during transitions of care.

Dosing errors occur when patients get switched from one concentration to another but volumes aren't adjusted...especially when they go in or out of the hospital.

For example, baclofen is often compounded as 1, 5, or 10 mg/mL...which can cause up to a ten-fold error if only a dose volume is known.

And in one case, an infant had life-threatening irregular heartbeats after receiving 4 mL of flecainide 20 mg/mL...instead of 4 mL of 5 mg/mL.

Get our resource to familiarize yourself with the 29 oral liquids that will now have standard concentrations...such as captopril 1 mg/mL, hydrochlorothiazide 5 mg/mL, and metoprolol 10 mg/mL.

Ensure your oral liquid compounding recipes match the standards...and ask your admin how you can assist with replacing recipes if needed.

Follow your pharmacy's policy on ensuring accuracy before adding new recipes...such as by asking a colleague to verify calculations.

Don't be surprised if your pharmacy stocks new commercially available products...spironolactone suspension (CaroSpir) or baclofen, lansoprazole, or metronidazole compounding kits...to reduce compounding errors.

Update preprinted labels and label templates for compounded oral liquids to match the standards.

Make sure the units on these match the standards too. Most units should be written as mg/mL. But remember the exceptions...clonidine 20 MICROgrams/mL, morphine 400 MICROgrams/mL, and sodium chloride 4 mEq/mL.

Stay alert for mismatches between the standard concentrations and concentrations shown on patient labels from your order entry system.

Report discrepancies to your admin or IT team...so they can get these fixed before an error occurs.

On med histories, continue to document doses of oral liquids in mg, not just mL...to avoid errors if a patient is still receiving a nonstandard concentration or a med withOUT a standard concentration.

See our CE, Compounding Topical Preparations and Oral Liquid Dosage Forms, for more ways to avoid errors with compounds.

Key References

  • www.ashp.org/-/media/assets/pharmacy-practice/s4s/docs/s4s-ashp-oral-compound-liquids.ashx?la=en&hash=4C2E4F370B665C028981

    B61F6210335AD5D0D1D6

Hospital Pharmacy Technician's Letter. Sep 2017, No. 330922



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