Vaidya VU, MD, Gaffoor MI, MD, Hilmas E, PharmD, and Mathews L, RN, Division of Pediatric Critical Care, University of Maryland School of Medicine, Baltimore, MD Introduction: Continuous infusions used in the PICU and NICU are most often compounded using the ‘Rule of Six’ (RO6) method, which results in a unique concentration for each patient weight. A recent mandate by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) requires hospitals to abandon the RO6 method in favor of the ‘Standard Concentration’ (SC) method, limiting the choice to only a few standard concentrations. Barring organizations that have been using the SC method prior to the mandate and those that have recently changed, for the remainder, compliance with the mandate is proving to be a daunting task. This is not surprising, given the wide range of weights and the need for precise control of fluid balance in pediatric and neonatal patients. The complexity is further increased as the shift to SC method necessitates a change at multiple levels involving physicians, pharmacists, and nurses. Our project goals were to develop a simplified, yet comprehensive computerized solution that would facilitate easy transition to the SC method, making it applicable in other institutions as well. Methods: The solution was implemented in two steps. Step (A): Identification of ideal standard concentrations. This was accomplished by developing a computerized program, the “Concentration Optimizer” which automated the task of rapidly generating two to four concentrations for each drug. An algorithm built into the program generated the concentrations when the following parameters were entered into the program; (i) minimum and maximum dose, (ii) dose titration interval, (iii) lowest patient weight (iv) lowest pump infusion rate (ml/hour), and (v) maximum acceptable fluid load resulting from the infusion. Step (B): Development of a Computerized Physician Order Entry (CPOE) program for ordering continuous infusions. Using just two of the data entry fields (dose and patient weight) for any selected drug, the CPOE program automatically selected a single “best” concentration from the 2 to 4 available concentrations that were generated by the “Concentration Optimizer” in Step (A). The selected concentration was such that it resulted in acceptable fluid load based on fluid limits set by the user. Users could override the computer to select an alternate concentration. The program then generated a comprehensive printout order that contained compounding instructions for pharmacy, administering instructions for nurses and a weight-specific dosing chart displaying infusion rates at all dose ranges. Additional features such as dose range checks, drug information, and other safety alerts were built into the program. Results: Using the Concentration Optimizer a list of two to four ideal concentrations was rapidly established for each of the forty drugs (www.icudrips.org/conc_list.html). The CPOE program enabled the user to order infusions by the SC method, requiring in fact fewer steps and no calculations, as compared to the RO6 method. The optimal concentration selected by the CPOE program resulted in clinically acceptable fluid load when tested for a wide range of weights (0.5 kg to 70 kg) and doses, for each of the forty drugs. The comprehensive printout instructions enabled the pharmacists and nurses to seamlessly transition to the new method. Conclusions: The “Concentration Optimizer” and the “CPOE program” provided a comprehensive yet simplified solution to implementing the SC method. We foresee that the program could be easily exported and rapidly implemented in other institutions. Standardizing the process across institutions would provide an additional layer of safety in use of continuous infusions in pediatric and neonatal patients.