Not 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.
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.
It might seem like a lot of waiting when you come to the Cancer Center for infusion, but there is good reason. Pharmacists and technicians have important roles in preparing each dose of chemotherapy, making your safety our top priority.
Everything starts when the pharmacy receives your order, which may be written ahead of time or on the same day after you see your physician. Pharmacists prevent medication errors, advise physicians on drug choices and make sure you understand your medication.
It’s about 2:30 p.m. on a Tuesday, and the infusion pharmacy is buzzing as its staff hunkers down to get through the University of Michigan Comprehensive Cancer Center’s busiest day of the week.
Pharmacist Diane Klemer
Pharmacist Diane Klemer breaks away — as a pharmacist does every day about this time — to huddle with nurses who coordinate each of the centers five infusion areas. Klemer scans the list of 130 patients scheduled for infusion treatments the next day. Her goal is to troubleshoot bottlenecks and problems: Are there too many patients coming in at 7:30 and 8 a.m.? Have patients who receive carefully timed treatments been scheduled appropriately?
“We find that if we spend 10 to 15 minutes the day before with each infusion area, talking through the next day’s schedule, we can address staff concerns, make corrections, if necessary, and provide better service the next day for our patients when they are here,” said Kelly Wright, manager of the Cancer Centers Infusion Pharmacy.
Nothing about chemotherapy is simple, especially not for those patients who have to endure its side effects while relying on it to treat their cancers. But few patients ever see the more than 100 health-care professionals working through a complex series of checks and balances to ensure the 36,000 infusion treatments delivered each year at the Cancer Center are appropriate and safe.
This is the story of just one of those many treatments.
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