Frequently
Asked Questions
Concentration Optimizer
1)How were the
concentrations generated?
2) Why are certain maximium concentrations higher than those in standard
references?
3)
Why do the number of concentrations vary from one to four?
4) How well do the concentrations work in the neonatal weight range?
Concentration Optimizer CPOE
1) How do I obtain the concentration
optimizer system?
2) Do I need smart pumps use standardized
concentrations?
3) How long does it take to implement the Concentration Optimizer system
in my ICU?
4) Does the Concentration Optimizer system
comply with the JCAHO mandate?
5) Is the Concentration Optimizer HIPAA
compliant?
6) Does the Concentration Optimizer work with my current
electronic medical record software (i.e. Cerner, Epic)?
Concentration Optimizer
1)How were the
concentrations generated?
The
concentrations listed in the table were generated in an automated and
scientific manner using the "Concentration
Optimizer" (Patent pending, University of Maryland School of
Medicine) , a software program that was specifically
developed for this purpose.
Click
Here for more information. Based on drug parameters, pump parameters
and desired fluid load entered into the program, the concentrations
generated were designed to meet the wide weight range (<0.5 kg preemie
to > 70 kg adolescent) and entire dose range for all drugs. The
automated concentrations were carefully scrutinized by the project team
and minor adjustments were made when necessary. The program algorithm was
designed to preferentially identify premixed commercial drip
concentrations in order to maximize the usage of premixed drips, obviating
the need for pharmacy compounding, and thus increasing and
efficiency. Testing demonstrated, that at every weight and dose range
(minimum to maximum), there always was one concentration that would be
optimum in terms of infusion rate (fluid rate)
2) Why are certain maximium
concentrations higher than those in standard references?
Standard Pediatric Pharmacy textbooks which were referred included,
Trissel's, the
Pediatric Dosage Handbook, and
The Teddy Bear Book . For
many drugs, the maximum concentration listed is so low that it
results in excessive fluid load in pediatric patients. For such drugs, the
concentrations that were clinically used at many large centers were taken
into consideration to suggest the maximum concentration. Thus the
concentrations listed above should not be considered as literature
evidence, rather each hospital should have their policies in determining
the maximum concentrations.
3)
Why do the number of concentrations vary from one to four?
Working
with pediatric patients, you will agree that whether it is Drips OR
Diapers: One Size Cannot Fit All!
Obviously,
if one concentration would meet the needs of the entire pediatric weight
range (from <0.5 kg to > 100 kg), then the very need for weight-based
dosing pediatric drugs would be in question. On the other hand,
greater than 5 concentrations for each drug, is almost contrary to the very
intent of JCAHO National Patient safety goal #3b, namely to "limit and
standardized" the number of concentrations. Thus, the
"Concentration Optimizer" was programmed to generate up to a
maximum of four concentrations. You will notice that for most drugs, the
program generates two to three concentrations. Only three drugs (Dopamine,
Naloxone, and Terbutaline) have four standard concentrations. There
are five drugs with only ONE concentration. Often the reason for this is
that the maximum concentration of the drip is limited by the concentration
of the vial. Example: Labetelol vial is supplied as 5 mg/ml, hence
the maximum drip concentration is limited by the vial concentration which
cannot exceed 5 mg/ml.
4) How well do the concentrations work in
the neonatal weight range?
One key element of the concentration optimizer is ensuring that the lowest
dose of every drug produces meaningful fluid rates for the lowest weight
NICU patients. In addition, we sought to provide enough concentrations so
even with high doses a neonate would not get fluid overloaded by our
drips.
Concentration Optimizer CPOE Software
1) How do I obtain the concentration
optimizer system?
The Concentration Optimizer System is owned by the University of Maryland.
Due to the demand for the CPOE system the University has sold
the Concentration Optimizer to
Healthprolink, a company which provides clinical software solutions to
healthcare organizations. They are currently preparing the program for
national release. Please
contact us to be kept informed on this process.
2) Do I need smart pumps
to use the Concentration Optimizer?
While "smart pumps", especially those with decision support technology
offer a high level of safety, they are are not necessary to use the
Concentration Optimizer thanks to multiple double checks built in to the
order form.
3)
How long will implementation of
Concentration Optimizer system take in my ICU?
We recently implemented the system in our PICU with a total of about 1-2
weeks of orientation for physicians, nurses and pharmacists. Thanks to the
easy layout of both the CPOE program and the order form little formal in
service was necessary. The "in-service" was built into the program. Many
users did not even realize they were switching from the rule of six to
standardized drips!
4) Does the Concentration Optimizer system
comply with the JCAHO mandate?
The concentration optimizer does not just meet the JCAHO mandate but
exceeds it significantly. While the JCAHO mandate regulates organizations
to change to standardized drips, it provides no suggestions on the safest
way to do this. The program provides multiple safety checkpoints at the
physician, pharmacy and nursing level to ensure safe drip delivery.
5) Is the Concentration Optimizer HIPAA
compliant?
The current version of the Concentration Optimizer CPOE does not store
patient information and as such is HIPPA compliant.
6) Does the Concentration Optimizer work with my current
electronic medical record software (i.e. Cerner, Epic)?
The Concentration Optimizer is programmed in VBA and Excel and is
currently meant to function as a stand alone product. However, we have not
ruled out integration with EMR software packages.
