CBAHI standards Medication Management 1-5.pdf

CBAHI standards

1. MM Hospital
Orientation Program

2. MM.1. Patient specific information.
MM.2. Pharmacy organization and leadership.
MM.3. Staffing and Scope of services.
MM.4. Compliance with Saudi laws and regulations.
MM.5. High-alert medications.
MM.6. Look-alike, sound-alike medications.
MM.7. Pharmacy and therapeutics committee.
MM.8. Hospital drug formulary.
MM.9. Handling non-formulary drug requests.
MM.10. Handling out of stock, shortage &disaster-needs of
medications.
MM.11. Storage of regular medication
Presentation Outlines

3. MM.12. Storage of refrigerated, frozen medications, biologicals
and vaccines.
MM.13. Storage and safe management of hazardous medications
and pharmaceutical chemicals
MM.14. Stability of medications available in multi-dose
containers
MM.15. Emergency medications, accessibility, availability, security
and monitoring.
MM.16. Medication management in patient care areas
MM.17. Medication management of patients’ own medications
MM.18. Medication management of narcotics and psychotropics
MM.19. Prescribing privileges
MM.20. Prescribing and transcribing medication orders
Presentation Outlines

4. MM.21. Types of medication orders
MM.22. Antimicrobial prescribing
MM.23. Verbal and telephone orders
MM.24. Non-formulary and off-label medication management
MM.25. Pharmacy review of medication order appropriateness
MM.26. Aseptic technique and CSPs compounding
MM.27. Parenteral nutrition management
MM.28. Chemotherapy compounding
MM.29. Non-sterile compounding (extemporaneous)
MM.30. Infection prevention and control in medication
management
MM.31. Uniformity and safety of medication distribution/
dispensing
Presentation Outlines

5. MM.32. Labeling of pharmaceuticals
MM.33. Medication management after hours
MM.34. Drug recall
MM.35. Patient drug counseling
MM.36. Safe drug administration
MM.37. Revision of medications before administration
MM.38. Self-administration
MM.39. Monitoring drug response
MM.40. Adverse drug reaction management
MM.41. Medication error, near misses management
Presentation Outlines

6. Patient specific information is readily accessible to all
healthcare professionals involved in the medication
management system
MM.1: Patient Specific
Information

7. Standard
MM.1 Patient specific information is readily accessible to all healthcare
professionals involved in the medication management system.
MM.1.1 The hospital has a multidisciplinary policy and procedure on patient specific
information to be readily accessible to all healthcare professionals. The information
includes, but is not limited to, the following:
MM.1.1.1 Patient’s age and sex.
MM.1.1.2 Current medications.
MM.1.1.3 Diagnoses, co-morbidities.
MM.1.1.4 Laboratory values.
MM.1.1.5 Allergies.
MM.1.1.6 Body weight and height.
MM.1.1.7 Pregnancy and lactation status.
MM.1.2 Except in emergencysituations, patient specific information is accessible
when needed to all healthcare professionals involved in the medication management
system.

8. Readily Accessible
•All essential patient’s information shall be immediately available, when
needed, to the healthcare provider.
•Such information could be accessible through electronic system (HIS) or
hard copy (paper-based medical record).
All healthcare professionals:
•Includes Physicians, pharmacists, nurses, other professional involved in
medication management.
Multidisciplinary team:
•A group of healthcare professionals who are participating in the
provision of patient’s care.
Definitions

9. •Medication management in hospitals is a complex procedure and
requires the collaboration of all healthcare givers.
•In order to ensure medication safety, patient specific relevant
information should be captured and documented in the patient’s
medical record so it remains available to all healthcare givers caring for
the patient.
•The essential information include:
•patient’s demographics,
•weight and height,
•current medications,
•known allergies to medications or to other allergens,
•diagnoses and co-morbidities,
•laboratory values and
•pregnancy and lactation status for women.
•Rarely, such information may not be fully available as in dire
emergenciesbut all efforts must be made to ensure its availability.
Intent and Key Points for Implementation

10. •Allergyto prescribed medication could be fatal. Allergy status shall be
known for all healthcare professionals at all stages of medication
management.
•Drug dosedepends on age (Pediatrics vs adults)
•Drug indication vary according to sex(such as hormonal Tx)
•Diagnosisand comorbidities are important to find the correlation with
prescribed medication and rule out wrong prescribing.
•Clinicians may elect to use drugs for un-approved (Off-label) indication.
•Knowledge of current medication helps healthcare provider avoiding
therapeutic duplication, drug-drug or drug-disease interactions.
•Laboratory values such as blood glucose, serum K+, Ca++, Mg++, PO3-,
creatinine, urea, liver function test, APTT, INR, etc. guides drug prescribing,
dispensing and administration and reduce the chance of medication error.
Background

11. Body weight and surface area:
•Drug dosing in pediatrics,and oncologypatients heavily depend on the
accurate measurement of body weight and calculation of body surface
area. Most of parenteral medications infusions for critically-illpatients
require updated daily body weight.
Pregnancy and lactation:
•Different medications have different safety profile during different stages
of pregnancy and during breast feeding.
•Healthcare provider need to know the stage of pregnancy and select the
safest medication accordingly.
•Sometimes breast feeding may be re-evaluated
•Breast feeding may be allowed after adjustment of drug administration
time.
Background

12. Emergency:
•During emergency, most of the patient specific information may not be
readily available to the healthcare provider.
•It is acceptable to do all necessary life-saving measures including
medication management in absence of some patient specific
information.
Background

13. •Hospital shall make all essential patient information accessible to
healthcare provider anywhere in the hospital.
•Review patient information before prescribing, dispensing and/or
administration.
•Do all necessary actions to prevent harm to your patient.
•Do not deny life-saving treatment if some of the essential information is
not available.
Recommendations & Tips for Implementation

14. The pharmaceutical care department has a clear
organizational structure and is directed by a qualified
pharmacist
MM.2: Organization
Structure

15. Standard
MM.2 The pharmaceutical care department has a clear organizational
structure and is directed by a qualified pharmacist.
MM.2.1 The pharmaceutical care department has a clear organizational structure.
MM.2.2 The head of pharmaceutical care is a licensedpharmacist, qualifiedby
education, training, and experience.
MM.2.3 The head of pharmaceutical care has a validprofessional registrationwith
the Saudi Commission of Health Specialties and Ministry of Health practice license in
Saudi Arabia, as applicable.
MM.2.4 The authoritiesand accountabilitiesof the head of the pharmaceutical care
is clearly delineated in a job description and updated every threeyears.

16. •Organizational Chart A diagram representing the structure of the
department and reporting relationships. It shows employee positions,
reporting relationships, and lines of authority.
•Pharmaceutical Care A patient-centered pharmaceutical practice in
which the pharmacist assumes responsibility for a patient’s
medication management issues and is held accountable for this
commitment.
•LeadersThe identified and designated individuals who have the
responsibility to oversee effective functioning of processes within a
defined scope of services.
•Authority: the power or right to give orders, make decisions, and
enforce obedience.
Definitions

17. •Accountability The ability of a system to track an individual’s actions,
or the acknowledgment and assumption of responsibility for actions,
products, decisions, and policies.
•Qualified pharmacist: Education/Certification, training, and
experience.
•Registered pharmacist: Valid professional registration with the Saudi
Commission of Health Specialties.
•MOH License: Ministry of Health practice license in Saudi Arabia, as
applicable.
•Job DescriptionA written statements that describes the duties,
responsibilities, required qualifications of candidates, and reporting
relationship and coworkers of a particular job.
Definitions

18. •The hierarchical arrangement of lines of authority, communications,
rights and duties of pharmacy shall be clearly illustrated.
•A clear organization structure defines how pharmacy activities such as
task allocation, coordination and supervision are directed towards the
achievement of pharmaceutical care.
•The structure shall determine the mode in which the pharmacy
operates and perform.
•Effective leadership is essential for the department to be able to
operate efficiently and to fulfill its mission.
•The head of pharmaceutical care is certified, trained, licensed
pharmacist who has valid registration with the SCHS.
•The essential functions, duties and responsibilities and
accountabilities of the head of pharmaceutical care is clearly written in
a job description.
Intent and Tips for Implementation

19. Example

20. •Develop your departmental organization chart.
•Define lines of authorities
•Define accountabilities
•Define chain of communication
•Specify titles and name
•Keep your chart update and signed
•Maintain valid registration and practice license.
•Update job description every 3 years, at least.
Recommendations & Tips for Implementation

21. The pharmaceutical care department has adequate
number of qualified staff.
MM.3: Staff and Qualification

22. Standard
MM.3 The pharmaceutical care department has adequate number of
qualified staff.
MM.3.1 The pharmaceutical care department has adequate numberof staff
qualifiedby education, training, and experience.
MM.3.2 There is a current staffing plan based on work load statistics that ensures
availability of sufficient staff resources to deliver the service.
MM.3.3 The staff responsible for intravenousadmixtures, parenteral nutrition,
chemotherapy, and drug information services have appropriate training and
competency assessment.
M.3.4 The qualitycoordinator has appropriate certification/training.
M.3.5 There is a structured orientationprogram where new staff are briefed on
pharmaceutical care and relevant aspects of the facility to prepare them for their
roles and responsibilities.
MM.3.6 There is a process to ensure that the new employee's competencyis
evaluated before allowed to work independently.
MM.3.7 There are continuingprofessionaldevelopmentactivities for all
pharmaceutical care staff.

23. •Competencyknowledge, skills, and attitudes required to
perform the job. Knowledge is the understanding of facts and
procedures. Skill is the ability to perform specific actions.
•Staff planningis a systematic process to ensure that an
organization has the right number of people with the right skills
to fulfill business needs.
Definitions

24. •Appropriate and adequate staffing is critical to patient care.
•Staffing plan is a systematic process to ensure that the
pharmaceutical care department has the right number of staff
with the right skills to fulfill service needs.
•Staffing plan depends on the department mission, functions and
services provided.
•Staffing plan should take in consideration, the job description,
job requirements such as skills, knowledge, and qualifications
needed for the job.
•Gathering statistics of productivity of your current workforce
help determines how much the average person can do in each
working hour.
Intent and Tips for Implementation

25. •Such statistics should be examined to evaluate the staffing
needs during the busiest periods.
•Due to the critical nature of the service, special training and
competencies are required for pharmacy staff working in:
•Intravenous admixture
•Total parenteral nutrition
•Chemotherapy
•Drug information services
•Quality coordination activities
•Staff orientation, competency assessment and continuous
professional activities are essential for provision of safe and
quality services.
Intent and Tips for Implementation

26. •Pharmacy has a written staffing plan, developed in collaboration with
the human resources department, to fulfill its part of the hospital's
mission.
•Pharmacy staffing plan defines the number, type, and qualifications
required for each position to fulfill the department’s responsibilities.
•The staffing plan ensures the services provided by staff meet the
health care needs of the patients.
•The staffing plan is consistent with the hospital strategic plan.
•The staffing plan is reviewed and updated at least annually.
•Head of pharmacy participate in the selection of new staff.
•The staffing plan is monitored to identify deficiencies and take
improvement actions accordingly.
Recommendation & Tips for Implementation

27. Competence Assessment Tools for
Health-System Pharmacies
Fifth Edition
Lee B. Murdaugh
E4030, 2015, 768 pages
Law/Regulatory/Accreditation;
Leadership/Management

28. Orientation:
•A new staff or a new job.
•It allows new staff members to hit the ground running.
•It instills new staff with confidence.
•It improves the possibilitythat staff will do a good job over the long
term.
•It makes life easier for others in the organization.
•Several days or weeks (at least one week)
•Documented in personnel file.
•Conducting an orientation at the right time makes more sense not
only for the staff member, but for the organization as well.
•Orientation, therefore, should best take place before the job starts.
Recommendations & Tips for Implementation

29. Orientation:
•Should give the staff:
•The basic information about the organization,
•The basic information about the position,
•The basic information about the target population and the
community.
•The employee can understand how to get where he wants to go.
Recommendations & Tips for Implementation

30. Specialized training and qualification program.
•Intravenous admixture,
•Total parenteral nutrition,
•Chemotherapy,
•Drug information services, and
•Quality coordination activities.
•A minimum of 4 weeks
•Written and signed program by the trainer/course provider
•Recognized training center.
•Competency assessment.
•Certification (Board, residency, diploma, quality degree, etc.)
Recommendations & Tips for Implementation

31. Continuous professional development (CPD):
•An ongoing, self-directed, structured, outcomes focused
cycle of learning and personal improvement.
•The responsibility of individual pharmacists for systematic
maintenance, developmentand broadening of knowledge,
skillsand attitudes, to ensure continuing competenceas a
professional, throughout their careers.
•The purpose of CPD is to ensure that pharmacists maintain
their knowledge, skills, and competencies to practice
throughout their careers in their specific area of practice;
improve personal performance; and enhance their career
progression.
Recommendations & Tips for Implementation

32. The pharmaceutical care and medication use in the hospital are
well planned and comply with laws and regulations of relevant
authorities and the Saudi Food and Drug Authority (SFDA).
MM.4: Planning & Compliance
with Laws & Regulations

33. Standard
MM.4 The pharmaceutical care and medication use in the hospital are well
planned and comply with laws and regulations of relevant authorities and
the Saudi Food and Drug Authority (SFDA).
MM.4.1 Organization and management of medications throughout the hospital
(procurement, storage, prescribing, preparing and dispensing, administration, and
monitoring) are guided by clear multidisciplinary plan or policy.
MM.4.2 Policies and procedures are developed in collaboration with relevant staff,
such as medical, nursing, and managementstaff.
MM.4.3 Updated policies and procedures manualis readily accessible to all
healthcare professionals involved in medication use.
MM.4.4 Appropriate sources of drug information are readily available to all
healthcare professionals involved in medication use. (e.g., books, manuals,
CDs/DVDs, online subscription to drug information resources).
MM.4.5 The pharmaceutical care services are provided twenty four hours a day,
seven days a week for inpatients and emergency patients.
MM.4.6 There is a pharmacist on-call whenever the inpatient pharmacy is closed.

34. 1
Selection
2
Procurement
3
Storage
4
Prescribing
5
Dispensing
6
Administration
7
Monitoring
Medication
Management

35. •Medications, as an important resource in patient care, must be
organized effectively and efficiently.
•Medication management is not only the responsibility of the
pharmaceutical servicebut also of managers and health care
practitioners.
•Individual responsibility to be clearly identified by the hospital
policies.
•Compliance with the country related laws and regulations is an
essential element for safe and appropriate use of medication in
any healthcare organization.
Intent and Tips for Implementation

36. •These laws and regulations were initially put in place by the
health authorities to ensure safe, secure, consistent and efficient
use of medication for all patients in the country.
•All disciplines involved in the medication use process shall be
aware of their related Saudi laws that govern their functions and
activities.
•To fulfill their professional obligations, appropriate resources of
drug information are made available to healthcare providers at
all times.
Intent and Tips for Implementation

37. •The pharmacy manual is designed to be a reference for all
Hospital staff in order to identify:
1. Pharmacy Policies & Procedures
2. Operational responsibilities
3. Departmental Relationships
4. Insure Safe and accurate medication ordering, preparation,
distribution and control
•Regularly updated.
Pharmacy Manual

38. •Pharmacy Manual Includes:
1.Hospital Organization
2.Pharmacy Department Functions (mission, vision, philosophy,
goals and objectives, code of ethics, etc..)
3.Services provided (such as IV, TPN, Chemo, Unit-dose, Extemp.
Preps. etc.).
4.Pharmacy Organization (functional organization, location and
extensions, operation hours, personnel, job description, general
rules and regulations, etc.).
5.Human resources Functions (orientation, performance appraisal,
continuing education, students mentoring).
6.Safety and occupational Hazards.(Cytotoxics, flammable and
other chemicals hazards).
Pharmacy Manual

39. Drug Information Resources

40. •The hospital should have a comprehensive policy to direct and
resource medication management.
•Every personinvolved in the medication management cycle
should be awareof and accept responsibility for their role.
•Each hospital manager and health care professional is
individually accountablefor his or her responsibilities.
•The hospital will evaluate the medication management
components of the episode of care to ensure continuity of the
patients’ medication managementhas been achieved.
Recommendations & Tips for Implementation

41. The hospital has a system for the safety of high-alert
medications
MM.5: High-Alert MedicationsESR

42. Standard
MM.5 The hospital has a system for the safety of high-alert medications.
MM.5.1 There is a written multidisciplinary plan for managing high-alert
medications and hazardous pharmaceutical chemicals. It includes identification,
location, labeling, storage, dispensing, and administrationof high-alert medications.
MM.5.2 The hospital identifies an annuallyupdated listof high-alert medications
and hazardous pharmaceutical chemicals based on its own data and national and
international recognized organizations (e.g., Institute of Safe Medication Practice,
World Health Organization). The list contains, but is not limited to, the following:
MM.5.2.1 Controlled and narcotics medications.
MM.5.2.2 Neuromuscular blockers.
MM.5.2.3 Chemotherapeutic agents.
MM.5.2.4 Concentrated electrolytes (e.g., hypertonic sodium chloride,
concentrated potassium salts).
MM.5.2.5 Antithrombotic medications (e.g., heparin, warfarin).
MM.5.2.6 Insulins.
MM.5.2.7 Anesthetic medications (e.g., propofol, ketamine).
MM.5.2.8 Investigational (research) drugs, as applicable.
MM.5.2.9 Other medications as identified by the hospital.
ESR

43. Sub-standards
MM.5.3 The hospital plan for managing high-alert medications and hazardous
pharmaceutical chemicals is implemented. This includes, but is not limited to, the
following:
MM.5.3.1 Improving access to information about high-alert medications.
MM.5.3.2 Limiting access to high-alert medications.
MM.5.3.3 Using auxiliary labels or computerized alerts if available.
MM.5.3.4 Standardizing the ordering, transcribing, preparation, dispensing,
administration, and monitoring of high-alert medications.
MM.5.3.5 Employing independent double checks.
MM.5.4 The hospital develops and implements standard concentrations for all
medications administered by intravenous infusion.

45. High Alert Medications
•Medications that have increased risk for causing significant
harm to a patient when used in error
•This term “High-Alert Medications” has been assigned to these
medications to draw attention to their potential danger
•Drugs are considered essential and cornerstone in drug therapy
•Medication errors with these drugs are not necessarily more
frequent but consequences may be more devastating
Definition

46. •High-alert medications are drugs that bear a heightened risk of
causing significant patient harm when used in error.
•Errors may not be more common with these than with other
medications, but the consequences of errors may be
devastating.
•Several worldwide organizations had identified a list of High
Alert medications such as WHO and ISMP.
•Hospitalsshall have a planfor the safe use of these medications.
•Hospitals shall develop their own list of high alert medications
with the related safety measures to minimize errors and harm
from these medications as much as possible.
Intent and Tips for Implementation

47. ISMP’s List of High
-
Alert Medications
www.ismp.org

48. High-Alert Medications
1.Insulin.
2.Antithrombotics& thrombolytics.
3.Controlled and narcotic medications.
4.Chemotherapy.
5.Concentrated potassium (chloride, phosphate, or acetate).
6.Concentrated electrolytes (2%, 3%, 5%, 14.6%NaClor 50%
MgSO4, Potassium chloride (2 mMol/ml)).
7.Paralyzing Agents (Neuromuscular blockers)
8.Anesthetics(including propofol, ketamine).
9.Investigational drugs.
10.Others

49. Betsy Lehman
Boston GlobeHealth Reporter
Died December, 1994
after receiving an
accidental four-fold
overdose of
chemotherapy.
Boston Globe, May 23, 1994

50. Severity of Medication Errors
PercentageNumberMedication Error category
10.723,698Potential Error -A
43.295,412Intercepted Error-B
38.6
6.2
85,286
13,661
No Harmful Error-C
-D
Harmful or Fatal Error
1.042,305E
0.24523F
0.0133G 1.3%
0.0365H Harm
0.0117I
100221,000Total
(n= 221,000)

51. Percentage
(%)
NumberMedication Error Category
3.951Potential Error -A
21.3227Intercepted Error-B
65.4849No Harmful Error-C & D
Harmful or Fatal Error
9.3121E-I
Insulin
www.nccmerp.org(1,298 reports 1/02-12/06)
Severity of Medication Errors

52. Insulin
•Insulin errors are usually
wrong dose and wrong
administration leading to
severe patient adverse
effects

53. Why Insulin?
1.Different insulin products in the market
2.Frequently used medicine
3.Look-alike/Sound-alike products (e.g. HumulinN vs.
HumulinR)
4.The use of error-prone abbreviation (uinstead ofunit)
5.Floor stock in all medical & surgical units
6.Non-standard compounding concentration of IV infusions
7.Different sliding scale and different dosing
8.Incorrect rates being programmed into an infusion pump

54. •Anticoagulation
–Heparin (Unfractionated)
–Warfarin
•Thrombolytic
–rtPA(Alteplase,
reteplase)
•Glycoprotein IIb/IIIainhibitors
(Eptifibatide)
Blood Coagulation Modifiers

55. Percentage
(%)
NumberMedication Error Category
6.92,470Potential Error -A
30.710,894Intercepted Error-B
59.221,018No Harmful Error-C & D
Harmful or Fatal Error
3.21,129E-I
Blood Coagulation Products
www.nccmerp.org(35,511 reports 01/2001-9/2004)
Severity of Medication Errors

56. •Multiple concentration
(1,000, 5,000, 25,000
units/ml).
•Look alike products
•Multi-dose vials.
•Confusion between heparin
and insulin.
•Dose calculation error.
•Non-standard
concentration for infusion
•Failure to monitor (aPTT).
Why Blood Coagulation Products?

57. The incident was an embarrassment to the hospital (Cedars-Sinai),
which has been a leader in patient safety, said Lucian Leape.
A massive overdose of heparin
given to three infants, including the
twins of actor Dennis Quaid, at
Cedars-Sinai Medical Center,
California.
The newborns' intravenous
catheters were flushed with the
adult therapeutic dose of heparin
(10,000 units/mL) rather than the
10-units/mLsolution typically used
for infants.
Heparin Overdose in Three Infants 2007

58. •Morphine, Fentanyl,
Pethidine, etc.
•Overdosing, over sedation,
confusion respiratory
depression, arrest, death.
•Even with appropriate
dosing, many patients may
experience harm from
narcotics.
•E to I category = 5.3%
Narcotics and Psychotropics

60. –Floor stock in critical care and other nursing units.
–Frequently used PRN for pain.
–Confusion between morphine and hydromorphone
–Non-standard concentrations of patient controlled
analgesia (PCA) solutions
–Lack of double check
WhyNarcotics and Psychotropics?

61. Experienced nurse followed
MAR, gave “morphine 5 mg IV”
initially and two hours later, the
same dose.
Four hours after the 2
nd
dose,
the baby arrested and died.
Death of Nine Month Old Baby Girl

62. –Concentrated magnesium
sulfate(50%).
–Undiluted injectablesolution
of potassium chloride,
potassium phosphate, and
potassium acetate.
–Hypertonic saline (sodium
chloride >0.9% solutions)
–E to I category = 2.8%
Concentrated Electrolytes

63. Premature baby died when umbilical catheter was flushed with “Potassium
chloride” not“Sodiumchloride”.

64. –Floor stock in nursing units.
–Multiple concentrations (NaCl3%, 5%, 14.6%).
–Frequently ordered medications.
–Mixing up different salts of potassium.
–Mixing up normal saline with potassium chloride.
–Lack of proper nursing education regarding concentrated
electrolytes.
–Lack of double check system.
–Non-standard concentration of potassium chloride solutions.
Why Concentrated Electrolytes?

65. Paralyzing Agents

66. Anesthesia Medications

67. Intrathecal, Epidural, IV PCA

68. Chemotherapy

69. Wt (Kg) 0.01 0.02 0.03 0.04 0.05 0.06 0.07 0.08 0.09 0.1 0.11 0.12 0.13 0.14 0.15 0.16 0.17 0.18 0.19 0.2
30 0.5 1 1.5 2 2.5 3 3.5 4 4.5 5 5.5 6 6.5 7 7.5 8 8.5 9 9.5 10
35 0.6 1.2 1.8 2.3 2.9 3.5 4.1 4.7 5.3 5.8 6.4 7 7.6 8.2 8.8 9.3 9.9 10.5 11.1 11.7
40 0.7 1.3 2 2.7 3.3 4 4.7 5.3 6 6.7 7.3 8 8.7 9.3 10 10.7 11.3 12 12.7 13.3
45 0.8 1.5 2.3 3 3.8 4.5 5.3 6 6.8 7.5 8.3 9 9.8 10.5 11.3 12 12.8 13.5 14.3 15
50 0.8 1.7 2.5 3.3 4.2 5 5.8 6.7 7.5 8.3 9.2 10 10.8 11.7 12.5 13.3 14.2 15 15.8 16.7
55 0.9 1.8 2.8 3.7 4.6 5.5 6.4 7.3 8.3 9.2 10.1 11 11.9 12.8 13.8 14.7 15.6 16.5 17.4 18.3
60 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20
65 1.1 2.2 3.3 4.3 5.4 6.5 7.6 8.7 9.8 10.8 11.9 13 14.1 15.2 16.3 17.3 18.4 19.5 20.6 21.7
70 1.2 2.3 3.5 4.7 5.8 7 8.2 9.3 10.5 11.7 12.8 14 15.2 16.3 17.5 18.7 19.8 21 22.2 23.3
75 1.3 2.5 3.8 5 6.3 7.5 8.8 10 11.3 12.5 13.8 15 16.3 17.5 18.8 20 21.3 22.5 23.8 25
80 1.3 2.7 4 5.3 6.7 8 9.3 10.7 12 13.3 14.7 16 17.3 18.7 20 21.3 22.7 24 25.3 26.7
85 1.4 2.8 4.3 5.7 7.1 8.5 9.9 11.3 12.8 14.2 15.6 17 18.4 19.8 21.3 22.7 24.1 25.5 26.9 28.3
90 1.5 3 4.5 6 7.5 9 10.5 12 13.5 15 16.5 18 19.5 21 22.5 24 25.5 27 28.5 30
95 1.6 3.2 4.8 6.3 7.9 9.5 11.1 12.7 14.3 15.8 17.4 19 20.6 22.2 23.8 25.3 26.9 28.5 30.1 31.7
100 1.7 3.3 5 6.6 8.3 10 11.7 13.3 15 16.7 18.3 20 21.7 23.3 25 26.7 28.3 30 31.7 33.3
105 1.8 3.5 5.3 7 8.8 10.5 12.3 14 15.8 17.5 19.3 21 22.8 24.5 26.3 28 29.8 31.5 33.3 35
110 1.8 3.7 5.5 7.3 9.2 11 12.8 14.7 16.5 18.3 20.2 22 23.8 25.7 27.5 29.3 31.2 33 34.8 36.7
115 1.9 3.8 5.8 7.7 9.6 11.5 13.4 15.3 17.3 19.2 21.1 23 24.9 26.8 28.8 30.7 32.6 34.5 36.4 38.3
120 2 4 6 8 10 12 14 16 18 20 22 24 26 28 30 32 34 36 38 40
Dr. Desouky Fayed
REGULAR NORADRENALINE (Levophed) Standard Drip for Adults
36 mcg/ml (3.6 mg/100ml or 9 mg/250ml D5W)
Jan-16
Dose (mcg/kg.min) --------------------------->
Infusion Rate in ml/hour ml/hr = [(mcg/kg/min) * (Wt) * (60)/Conc.(mcg/ml)]
Inpatient Pharmacy - IV admixture Section Ext. 5522

70. Wt (Kg) 0.1 0.12 0.14 0.16 0.18 0.2 0.22 0.24 0.26 0.28 0.3 0.32 0.34 0.36 0.38 0.4 0.42 0.44 0.46 0.48 0.5
30 2.5 3 3.5 4 4.5 5 5.5 6 6.5 7 7.5 8 8.5 9 9.5 10 10.5 11 11.5 12 12.5
35 2.9 3.5 4.1 4.7 5.3 5.8 6.4 7 7.6 8.2 8.8 9.3 9.9 10.5 11.1 11.7 12.3 12.8 13.4 14 14.6
40 3.3 4 4.7 5.3 6 6.7 7.3 8 8.7 9.3 10 10.7 11.3 12 12.7 13.3 14 14.7 15.3 16 16.7
45 3.8 4.5 5.3 6 6.8 7.5 8.3 9 9.8 10.5 11.3 12 12.8 13.5 14.3 15 15.8 16.5 17.3 18 18.8
50 4.2 5 5.8 6.7 7.5 8.3 9.2 10 10.8 11.7 12.5 13.3 14.2 15 15.8 16.7 17.5 18.3 19.2 20 20.8
55 4.6 5.5 6.4 7.3 8.3 9.2 10.1 11 11.9 12.8 13.8 14.7 15.6 16.5 17.4 18.3 19.3 20.2 21.1 22 22.9
60 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25
65 5.4 6.5 7.6 8.7 9.8 10.8 11.9 13 14.1 15.2 16.3 17.3 18.4 19.5 20.6 21.7 22.8 23.8 24.9 26 27.1
70 5.8 7 8.2 9.3 10.5 11.7 12.8 14 15.2 16.3 17.5 18.7 19.8 21 22.2 23.3 24.5 25.7 26.8 28 29.2
75 6.3 7.5 8.8 10 11.3 12.5 13.8 15 16.3 17.5 18.8 20 21.3 22.5 23.8 25 26.3 27.5 28.8 30 31.3
80 6.7 8 9.3 10.7 12 13.3 14.7 16 17.3 18.7 20 21.3 22.7 24 25.3 26.7 28 29.3 30.7 32 33.3
85 7.1 8.5 9.9 11.3 12.8 14.2 15.6 17 18.4 19.8 21.3 22.7 24.1 25.5 26.9 28.3 29.8 31.2 32.6 34 35.4
90 7.5 9 10.5 12 13.5 15 16.5 18 19.5 21 22.5 24 25.5 27 28.5 30 31.5 33 34.5 36 37.5
95 7.9 9.5 11.1 12.7 14.3 15.8 17.4 19 20.6 22.2 23.8 25.3 26.9 28.5 30.1 31.7 33.3 34.8 36.4 38 39.6
100 8.3 10 11.7 13.3 15 16.7 18.3 20 21.7 23.3 25 26.7 28.3 30 31.7 33.3 35 36.7 38.3 40 41.7
105 8.8 10.5 12.3 14 15.8 17.5 19.3 21 22.8 24.5 26.3 28 29.8 31.5 33.3 35 36.8 38.5 40.3 42 43.8
110 9.2 11 12.8 14.7 16.5 18.3 20.2 22 23.8 25.7 27.5 29.3 31.2 33 34.8 36.7 38.5 40.3 42.2 44 45.8
115 9.6 11.5 13.4 15.3 17.3 19.2 21.1 23 24.9 26.8 28.8 30.7 32.6 34.5 36.4 38.3 40.3 42.2 44.1 46 47.9
120 10 12 14 16 18 20 22 24 26 28 30 32 34 36 38 40 42 44 46 48 50
Dr. Desouky Fayed Jan-16
Dose (mcg/kg.min) --------------------------->
Inpatient Pharmacy - IV admixture Section Ext. 5522
Infusion Rate in ml/hour ml/hr = [(mcg/kg/min) * (Wt) * (60)/Conc.(mcg/ml)]
CONCENTRATED NORADRENALINE (Levophed) Standard Drip for Adults
72 mcg/ml (7.2 mg/100ml or 18 mg/250ml D5W)