I am writing to see how folks are approaching the administration of premixed medications to pediatric patients for doses that result in volumes greater than 50 mL (so they cannot be infused on a syringe pump).

We are a children’s program in an adult hospital enterprise, and some of our hospitals do not have a 24 hour pharmacy, so current state is to hang the premix bag on a large volume pump and use the “volume to be infused” (VTBI) programming. For example, if a dose is 76 mL of a medication that is available as a 100 mL premix, the nurse will program the pump to administer 76 mL. This is problematic because: pumps are sometimes programmed incorrectly and the entire premix is administered, if primary tubing is used usually ~20 mL of the dose may not be administered, sometimes covering nurses think the dose hasn't been administered because there is still med in the bag and they administer the rest of the bag, and if the patient is transferred via ambulance to another hospital the entire dose may be administered.

We’re evaluating asking RNs to remove volume from the premix before hanging the bag but the potential for error in calculating the amount to be removed is high and some premixes don’t have ports from which excess volume can be removed.

Any input you have on how you have managed to standardize your medication administrations would be helpful. We are an Epic system using Baxter Spectrum IQ pumps.

Thank you,
Leslie Sanchez
Presbyterian Healthcare Services