avatar

Standardizing medications to ensure patient safety

Patient Safety Spotlight - Medication StandardizationNot all medications are formulated by manufacturers in dosages appropriate for children. Pharmacies make those medications by compounding them — meaning they crush and dissolve the adult medication and suspend it in liquid in a dosage appropriate for the child’s size. The problem is that different pharmacies may compound the same medication at different concentrations — meaning a teaspoon of medication from one pharmacy may not be the same as a teaspoon of the same medication from another pharmacy.

Statewide study

We wanted to investigate the prevalence of compounding variability and create a solution that would decrease the potential for medication adverse events occurring due to inadvertent wrong doses being administered. Data was collected that identified 147 medications that are compounded for children and found that there were 470 different concentrations of those medications being made. The concentrations of which varied widely.

Creating standards

Then we looked at published research for each of the medications to determine the best formulation. We developed a set of proposed standard concentrations. Throughout the process, we involved the other children’s hospitals in Michigan as well as the various professional medical associations and the state health and hospital association. The new compounding standards are now available at www.mipedscompounds.org.

First in the country

Michigan is the first state in the country to have developed medication compounding standards. Led by the team at C.S. Mott Children’s Hospital, with help from multiple other organizations, these standards are helping improve patient safety statewide. Pharmacists can easily visit the free website to see the standard formulations for more than 100 medications. This helps ensure that no matter where a child receives his or her medication, it’s the same medication in the same concentration.

What’s next

We’re still working to achieve 100 percent compliance with the standards statewide, and are partnering with the American Society of Hospital Pharmacists to take the standards to a national level. This initiative received the Institute for Safe Medication Practices Cheers Award in 2014. It’s exciting to see the standards roll out and know that we have made medications safer for children across the state — and hopefully soon, the country.

Take the next steps


Meet Deb Wagner, PharmDDeborah Wagner received her bachelor’s degree in Pharmacy and her doctor of Pharmacy from the University of Michigan. Since 1993 she has been involved with the operating room pharmacy program at the University of Michigan Health System and oversees the clinical pharmacy functions of three operating room pharmacy satellites. She now serves as the Pediatric Safety Coordinator, Office of Clinical Affairs and Clinical Associate Professor of Anesthesiology in the School of Medicine and Clinical Associate Professor the College of Pharmacy at the University of Michigan.

best children's hospitalsUniversity of Michigan C.S. Mott Children’s Hospital is consistently ranked one of the best hospitals in the country. It was nationally ranked in all ten pediatric specialties in U.S. News Media Group’s “America’s Best Children’s Hospitals,” and among the 10 best children’s hospitals in the nation by Parents Magazine. In December 2011, the hospital opened our new 12-story, state-of-the-art facility offering cutting-edge specialty services for newborns, children and women.