Our ED provider group has concerns about delays in compounding of patient-specific weight-based levetiracetam for status epilepticus as it comes from our pediatric pharmacy satellite or from our central pharmacy (during limited hours on the weekends).

Our neuro group favors the 60 mg/kg loading dose with max of 4500 mg, and I received mock-up of an order set today that I have multiple concerns about. It involves utilizing multiple bags to get to the desired dose so the RN can access the drug from the Omnicell. I have a lot of concerns about how it is written and where this proposed process will fail. For example, for a patient weighing 42.5-44 kg, the order set directs them to choose 3 orders: 1000 mg premix (from Omnicell), 1500 mg premix (from Omnicell), and a 5 mg/kg dose to come from pharmacy. There are sections in the order set for 19(!) weight ranges. It's all written out correctly indicating what the total dose is, etc. but I anticipate that we are going to have issues with ordering the right thing (providers would need to select all bags under the correct weight category), and with nurses giving all of the ordered bags and truly understanding what the total dose is vs. task duplication on the MAR. (We are a Cerner facility, and I don't believe we have the chained orders functionality like Epic has).

Does anyone have a protocol for dose rounding or alternative solutions for this medication?