Standardized Vasoactive Medications: A Unified System for Every Patient, Everywhere

Abstract

Providing medications used in emergency cardiovascular care (ECC) in an efficient and consistent manner is a cornerstone for achieving excellent patient care and safety. For neonatal, pediatric, and adult patients who move through different specialty areas in a tertiary hospital, it is essential to have a standardized protocol for these medications that can be followed regardless of location or practitioner. Our institution developed a protocol for intravenous push (IVP) and continuous infusion (CI) medications based on the Neonatal Resuscitation Program (NRP), Pediatric Advanced Life Support (PALS) and Advanced Cardiovascular Life Support (ACLS) guidelines. This protocol incorporates these guidelines into a single reference sheet (Emergency Drug Sheet) based on the patient's weight using a computer software program. The program provides the option for either pediatric (weight-based) or adult (weight-based and standard dose) dosing. The CI section uses a limited number of concentrations, which meets the JCAHO mandate. Commercially available products are used, when possible, in response to USP <797>. It also serves as the standard protocol for vasoactive medications in all patient care settings in conjunction with programmable infusion pump technology. The software program is easy to use; the Emergency Drug Sheet is easy to read; and the program is available everywhere in the hospital. The standard CI protocol used with the Emergency Drug Sheet reduces unclear orders, standardizes drug preparation, and decreases the time to medication delivery. It could serve as a model for community hospitals, as well as tertiary facilities.