Pediatrics Standardized Concentration of Miscellaneous Mediations Intravenous Infusion: A New Initiative in Saudi Arabia

Yousef Ahmed Alomi* , BSc. Pharm, MSc. Clin Pharm, BCPS, BCNSP, DiBA, CDE, Critical Care Clinical Pharmacists, TPN Clinical Pharmacist, Freelancer Business Planner, Content Editor and Data Analyst, Riyadh, Saudi Arabia. Hani Alhamdan, BSc.Pharm, MSc. Pharm, MBA, Director, Pharmaceutical Care services Department at KAMC-Jeddah, Ministry of National Guard, Saudi Arabia. Faiz Abdullah Bahadig, R.Ph, Informatics Pharmacist, Pharmaceutical Care Department, King Abdul-Aziz Medical, City-WR-Jeddah, Ministry of National Guard, Saudi Arabia.


INTRODUCTION
The medication errors prevention is vital in the neonatal and pediatrics field. [1] The pharmacist had a crucial role in the intervention and medication mistakes prevention of neonates' and pediatrics patients in Saudi Arabia. [1] Besides, the pharmacist properly decreases the economic burden on the pharmacy and healthcare system. [2] The majority of mistakes were dosing related and measured as the third type of errors. Various medications involved in mistakes, not specialized groups of medications. [1] Multiple literatures discussed pediatrics and neonate's standardized concentration of high-risk medications. It included cardiopulmonary medication, electrolyte and total parenteral nutrition for neonates' and pediatrics. [3][4][5][6] However, some miscellaneous medications not discussed in those literatures. The authors were not familiar with any investigations based on their knowledge discussed the pediatrics or neonatal standardized concentration of miscellaneous medications not involved antibiotics, chemotherapy, cardiovascular medications and central nervous system medications. [7][8][9] The aim of the current review is to declare the neonatal and pediatrics standardized concentration of intravenous infusion of miscellaneous medication as new initiatives project in the kingdom of Saudi Arabia.

Method of the Project
It is a new initiative project drove by the national IV admixture programs. The task force team of pediatrics and neonates' standardized miscellaneous medications concentration formulated and contained from the author's expertise in the parenteral medications. All antibiotics, chemotherapeutic agent CNS medications, cardiovascular medications will be excluded from the revision. The committee utilized and drove the pharmacy parenteral administration guidelines, from the textbook and international literature pediatrics and neonates' standardized concentration of miscellaneous medications. It was written by utilizing the international business model, pharmacy project guidelines and project management institution guidelines of a new project. [10][11][12][13] The pediatrics and neonate's standardized concentration adjusted based on the drug strength, acceptable concentration, daily dose and the volume of bag as possible. The project is written through project management professionals and entailed of several parts, including the initial phase, the planning phase, the execution phase, the monitoring and controlling phase.
International Journal of Pharmacology and Clinical Sciences, Vol 9, Issue 4, Oct-Dec, 2020

Initiative Phase Assessment Needs
The majority of the intravenous admixture services in the pharmacy unit made guidelines for parenteral dilution and administration of the medications special for them. The guidelines comprised of medications, drug strength, rate of administration and stability of intravenous infusions. The pharmacists and pharmacy technician prepares multiple medications with various concentrations and different diluent solutions. Moreover, the healthcare providers, including physicians and nurses, might deal with a different method of administration with multiple concentrations and various solutions. The pediatrics and neonate's standardized concentration of medications are essential to prevent drugrelated errors. The workload of healthcare professionals might be enlarged through prescribing or dispensing and administration of multiple concentration medications. The various factors of the workforce may affect the safety culture and lead to medication errors. If the unified concentration with the solution will lessen the workload and prevent medication errors.

SWOT Analysis
The SWOT analysis measured one of the common tools for each new project analysis. The SWOT analysis stands for strength, weakness, opportunities and threats. The strengths points of the project are set up the medication safety and prevention of mistakes, reductions of pharmacy and healthcare provider workload, while the weak points are limited medication concentration and few numbers of diluent solution. The opportunities points are quality methods for accreditation and patient safety program implementation. The threat points are if the pharmacy strategic plan does not happen and if the administration planner not available.

Market Analysis
The majority of the intravenous admixture service had a specific method of parenteral medications. The manual of preparation comprised of medications, route of administration, the stability of preparation, with normal and maximum concentration and medication compatibility. Most of the governmental or private healthcare organizations had the same guideline with different medications. There is no standardized concentration for medications or standardized diluent solutions for pediatrics or neonates' . It is a special method for standardized concentration to reassure pharmaceutical companies to manufacture the same, although some ready-made medications with specific standardized concentration a variable in the market.

Planning Phase Scope of the Project
The project covers a pediatrics and neonates' standardized concentration of miscellaneous intravenous medications. It is not comprised antibiotics, cardiovascular medications, CNS medications and chemotherapy agents including common and maximum concentration based on the dosage, frequency administration and medications strength. Moreover, the diluent solution for pediatrics and neonates' miscellaneous medications.

Vision, Missions, Goals
The vision of the project is to reach the best pediatrics and neonate's standardized concentration of intravenous infusion of miscellaneous medications, while the message to provide the appropriate pediatrics and neonates' fixed standardized concentration of intravenous infusions of miscellaneous medications with appropriate diluent solutions. The goals of the project is to fix the pediatrics and neonates' standardized concentration of intravenous infusion of miscellaneous medications, to inhibit any mistakes related to medication concentration, to reduce the workload for pharmacy staff, healthcare providers and to avoid the other needless and additional cost on the pharmacy and healthcare system.

Project Description
The following policies were put in place for every pharmacy staff and other health care individuals: ✓ The intravenous admixture committee (IAC) should be formulated at healthcare organizations. ✓ The IAC committee should contain of IV pharmacist and pharmacy technician, pediatrics nursing representative, neonates' nursing representative and pediatrics surgical or medical representative and neonatal surgical or physician and nurse representative. ✓ The committee revises the standardized concentration of pediatrics and neonate's miscellaneous medications and updates at least annually (Table 1). ✓ The education and training sessions should be conducted by the committee to all healthcare providers, including pediatrics and neonates' , physicians and nurses, with pharmacy staff.

Plan Cost Management
Every new project, the management team must set out the financial budget, which includes the cost of educational courses pediatrics and neonates' healthcare professionals, the cost of the management team meeting and the cost of updated references. The budget must be supervision over a while until the project ended and switch to the operating system.

Executing Phase Management Team
Project management professionals had various steps. One of the essential steps was executing phase, which had a team lead the program or the project from the beginning until becoming one of the operating systems at a healthcare organization.

Education and Training
Every new project entails special education and training for concern people. This project desires education and training for pharmacy staff, including pediatrics and neonates' clinical pharmacists, pediatrics and neonates' pharmacists and pharmacy technicians. The healthcare professionals, counting pediatrics and neonates' physicians and nurses, need another special education and training. Moreover, the team management needs orientation education about the project for all healthcare professionals. The orientation emphasis on for any new staff healthcare providers joined the healthcare institutions.

Monitoring and Controlling Phase Project Total Quality Management
There are numerous tools used for total quantity management with new project pediatrics and neonates' standardized concentration of miscellaneous medications during the implementation phase and reflect the impact and the balance scored cards was among them. [14] The tools monitor consisted of four-part that's including the customer, finance, internal process, education and innovation.

Risk Management
There are various measured risks including schedule risks, scope risks, budget risks, International Journal of Pharmacology and Clinical Sciences, Vol 9, Issue 4, Oct-Dec, 2020 personal risks, technical risks and quality risks. [15,16] The project mostly exposed to risks such as personnel, budget, technical and quality risks. The project correctly suffered from personal risks with not trained healthcare professionals or nor sufficient pharmacists and pharmacy technicians. The budget risk was not covered the education and training courses for all pharmacy staff and healthcare professionals. There is another of technical risk maybe exposed. The technical risk, which is limited to electronic recourses, or not friendly use computer system in pharmacy practice. The project maybe exposed to quality risks with not implemented pediatrics and neonates' medications safety tools or non-trained personnel.

Closing of the Project
The standardized concentration of pediatrics and neonates' miscellaneous medications at all healthcare organizations of governmental and private sectors are mandatory to prevent drug-related mistakes, lead to morbidity and mortality and avert an economic burden on pharmacy and healthcare systems, including the hospitals and primary healthcare centers services in Saudi Arabia. The project should endure at the intravenous admixture of pediatrics and neonates' parenteral medications at each pharmacy unit and keep supervision through related committees. The standardized pediatrics and neonates' concentration education and training should be implemented accordingly.
Pediatrics and neonate's miscellaneous medications concentration should inform regularly and expand the number of medications is recommended in the future. The annual celebration of all intravenous admixture pediatrics and neonates' pharmacy staff, including pharmacists and pharmacy technicians is highly optional in Saudi Arabia.