Adult Standardized Concentration of Cardiovascular Medications Intravenous infusion: A New Initiative in Saudi Arabia

Objectives: To declare the adult standardized concentration of cardiovascular intravenous infusion as a new initiative in the Kingdom of Saudi Arabia. Methods: It is a new initiative project drove by national standardized concentration of cardiovascular services. The projects formulated from the international business model, pharmacy project guidelines and project management institution guidelines of a new project. The initiative project is written through project management professionals and consisted of several parts, including the initial phase, the planning phase, the execution phase, the monitoring and controlling phase. Results: The adult standardized concentration of cardiovascular medications intravenous infusion services defined as vision, mission and goals. The services had various benefits including clinical and economic on patients, the continuous of the project assured by risk management model description and the monitoring and controlling of the services as illustrated in the review. The transition to operation project though closing project stage explored in the analysis. Conclusion: The adult standardized concentration of cardiovascular intravenous infusion services is a new initiative part of the intravenous admixture program. The standardized concentration of cardiovascular will diminish healthcare professional workload and avoid economic burden on healthcare system; it is highly recommended to implement in the Kingdom of Saudi Arabia.


INTRODUCTION
Medication errors are the foremost issues in the treatment process that leads to harm to hospitalized patients. [1][2][3] One of the significant medication errors that can occur in the hospital settings and is utilizing numerous intravenous infusion medications. Several studies showed that errors involving intravenous infusion medications have great potential to cause serious harm to hospitalized patients. [4][5][6] Standardizing concentrations of high-risk intravenous medications are being used to reduce medication errors that inevitably leading to a safer delivery system. [7][8][9][10][11][12][13] Cardiovascular medications characterize one of the important and highly used medications in hospitalized patients. [11][12][13] There are many medication errors have been documented of cardiovascular medications, which have many different concentrations. [5] This project purposes to prevent or at least reduce these types of medication errors by implementation and development system responsible for determining specific concentration for cardiovascular medications used in the settings of Kingdom of Saudi Arabia.

METHODS
It is a new initiative project drove by the national intravenous program. [14] The task force team of adults standardized concentration of cardiovascular intravenous infusion medications formulated and contained of from the author's expertise in the adults parenteral medications. The committee utilized and drove the pharmacy parenteral administration guidelines and from the textbook and international literature adults standardized concentration of cardiovascular intravenous infusion medications written by utilizing the international business model, pharmacy project guidelines project management institution guidelines of a new project. [15][16][17][18] The adult's standardized concentration of cardiovascular intravenous infusion medications adjusted based on the acceptable concentration, daily dose and the volume of bag as possible. The project is written through project management professionals and contained of several parts, including the initial phase, the planning phase, the execution phase, the monitoring and controlling phase.

Assessment Needs
Multiple hospitals have been used in numerous concentrations of cardiovascular infusion medications. Besides creating economic challenges on healthcare institutions, the use of different concentrations of cardiovascular medications may lead to medication errors that may cause adverse effects to patients and, in the long term, caused deaths. The best way of International Journal of Pharmacology and Clinical Sciences, Vol 9, Issue 2, Apr-Jun, 2020 reducing and preventing such instances is by standardizing the prevailing concentrations.

Market Analysis
Most of the parenteral admixture services in the Kingdom of Saudi Arabia had various methods of adult cardiovascular intravenous medication concentrations. The guidelines of preparation comprised of medications, route of administration, the stability of preparation, concentration and medication compatibility. Most the healthcare organizations had the same guidelines with different medications. The adult standardized concentration of cardiovascular intravenous infusion or standardized diluent solution has not existed. The adult standardized concentration of cardiovascular intravenous infusion is an excellent method to reassure the manufacturers to produce the same readymade, standardized concentration. However, there were some ready-made medications with specific concentration a variable in the market but coveted all adult's cardiovascular medications and the concentration was not proper.

SWOT Analysis
To attain the goals of the project, a SWOT analysis was carried out. The "strengths" of the project were accompanied by the documentation of pharmacy workload for the prevention of medication errors, the estimated cost of avoidance of medication errors and the estimated cost of correction of medication errors. A limited number of resources accompanied the "weaknesses" in this project adult's standardized concentration of cardiovascular intravenous infusion medications and diluent. The opportunities that were looked into in this project encompassed the implementation of both international and local standards of healthcare organizations. It also needed how to implement the New Saudi Vision 2030 and limiting the errors that cause by using various concentration. The threats of the project included the change of pharmaceutical administration and also an analysis of the standards for accreditation.

Planning Phase Scope of the Project
The project confined the adult's standardized concentration of cardiovascular medications with specific diluent solutions. The concentration drove from typical daily dose and frequency administration. The adults' standardized concentration of cardiovascular intravenous medications encourages pharmaceutical companies to make readymade antibiotics with resembling concentration and diluent solution.

Vision, Missions and Goals
The project's vision is to best standardization and limits the drug concentrations at healthcare institutions, particularly for drugs used in cardiovascular treatment. The mission of the project is to standardize the adult's concentrations of intravenous infusion of cardiovascular medications. The project goals included the facilitation of standardization drug concentration, preventing complications from unstandardized drug concentrations, reducing the errors, mortality, the economic challenges on the healthcare system and reduce the workload of the healthcare providers and pharmacy.

Description of the Project
The following policies were put in place for every pharmacist and other health care individuals: 19

Plan Cost Management
The demand budget should be detailed in every current project of adult standardized concentration of cardiovascular intravenous infusion. The cost, including the educational courses, the management team meeting and updated references. Furthermore, the budget should be supervision for the overall period.

Executing Phase Management Team
The adult standardized concentration of cardiovascular intravenous infusion project should lead by the administration team. The team entailed of adult cardiovascular clinical pharmacists, adult's intravenous admixture pharmacists, pharmacy technicians, cardiology physicians, surgeons, pharmacy total quality management and adult medications safety pharmacist. The team will implement and monitor the project. Set-up the performance indicators, policies and procedures. In addition to updating the adult standardized concentration of cardiovascular intravenous infusion list occasionally. Perform all education and training of the project for pharmacists and healthcare providers and related issues.

Education and Training
Various educational and training sessions about the adult standardized concentration of cardiovascular intravenous infusion should be conducted for pharmacy staff, including pharmacists, pharmacy technicians and healthcare providers, including physicians and nurses, should receive education and training before starting the project. Another candidate for

Project Total Quality Management
There are multiple tools practice during total quantity management with new project adult's standardized concentration of cardiovascular medications during the implementation stage and reflect the outcomes. The balance scored cards was among them. [21] The elements monitor involved of four-part including the finance, the customer, internal process, education and innovation. The assessment of healthcare and pharmacy services of adult's standardized concentration of cardiovascular medications was an example of an internal process type. The clinical impact of adult's standardized concentration of cardiovascular medications, which adequately reflect the education, competency of pharmacists and pharmacy technicians, was an example of the education type. The financial type had another example of measuring the avoidance cost of the adult's standardized concentration of cardiovascular system medications. The last type of quality management was the customer types through measures the patient's satisfaction with healthcare providers, including pharmacy staff of adults standardized concentration of cardiovascular system medications satisfaction in the Kingdom of Saudi Arabia.

Risk Management
There are several considered risks including budget risks, scope risks, schedule risks, personal risks, technical risks and quality risks. [22,23] The project might be exposed to risks such as personnel, budget, technical and quality risks. The project suffered sufficiently from personal risks with not trained pharmacist or pharmacy technician or nor sufficient pharmacy staff. The budget risk is not just enough education and training courses to all healthcare providers' related issues. It might expose to the same. There is another of technical risk may be exposed without the electronic recourses of friendly used computer system in pharmacy practice. The project may be exposed to quality risks with nonimplemented medications safety elements or non-trained personnel.

Closing of the Project
The standardized concentration of adult's cardiovascular medications at all healthcare organizations of governmental and private sectors is required to prevent drug-related misadventures and might lead to morbidity and mortality. Moreover, to prevent additional redundant cost burden on healthcare institutions, including the hospitals and primary healthcare centers services in the Kingdom of Saudi Arabia. The project should continue during the preparation of parenteral cardiovascular medications at each pharmacy unit and related committees. The standardized adult's concentration of cardiovascular medications education and training should be implemented periodically.
Adult's cardiovascular medications concentration should be updated and more expand the number of medications in the future. The annual celebration of all IV admixture pharmacy staff, including the pharmacist and pharmacy technician, is highly suggested in the Kingdom of Saudi Arabia.