Editor's Note: Intravenous Admixture Pharmacists: A Thing of the Past?

Mr. McAllister is a health-systemsconsultant based in Chapel Hill, NorthCarolina.

I was surprised last week when afriend confided that she was on theverge of outsourcing her intravenous(IV) admixture services to a nearby company.Directors of pharmacy and theirstaffs have been challenged by the needfor space and getting funding for capitaland renovation costs to come into compliancewith USP 797 standards. Similarly,the Joint Commission has promulgatedstandards that have shifted the additionalIV compounding workload fromstaff (usually nurses) in environmentssuch as procedure clinics and labs, theemergency department, and ambulatoryclinics. We also strive to limit nursecompounding to emergent IV preparationsand have assumed preparation ofas many first doses as possible to complywith the same standard. Medicationerrors associated with IV admixturesare more visible than ever before, andquality improvement efforts commonlytranslate to more effort expected fromstaff without additional staff. My colleaguehad most of this under controlor plans in place, but her decision wasprimarily driven because she could nothire pharmacists who were willing towork in the IV admixture service. Whata shame!

Regrettably, pharmacy leaders, faculty,and even professional associationshave contributed to this phenomenon.Over the past 2 or 3 decades, we haveappropriately promoted the notion thatpharmacists should focus their attentionon optimizing drug therapy and spendingthe majority of their time on patient careunits with patients and other providers.The flaw in this approach has all toooften been to glamorize pharmacists'practices that are patient-focused at theexpense of practices that have historicallyrestricted their efforts to centralizefunctions. We have not taken an entrepreneuriallook at the responsibilitiesof IV admixture pharmacists to enablethem to assume patient-specific drugtherapy oversight responsibilities. Whata shame!

I wrote an editorial a couple of yearsago in Pharmacy Times about IV compoundingservices and called for innovationand cooperation with the industry toreexamine products available and makeefforts to improve IV admixture systems.Even then, intelligent pumps were available,and some IV automation had cometo market. Infusion devices with decisionsupport software have continued toevolve and improve, and more recently,IV compounding robots have becomeavailable to further support IV admixtureservices. From my perspective, this is atruly exciting time when our professioncan reinvent IV admixture services tomore closely meet current health caretrends and prepare for the future.

We know that medication errors relatedto IV therapy are a phenomenon thatmust be significantly improved. As morecomplex care requiring IV therapies isprovided in clinics and similar environments,pharmacy departments mustbe prepared to support the patient'smedication needs appropriately. Thegenomics evolution will likely result inpharmacy departments being askedto provide never before seen IV compoundingservices to support individualizedtherapy. Finally, the quality of thefinal compounded admixture is anotherdimension that has not enjoyed thefocus that it deserves.

I suggest that what is needed is forpharmacy leaders and practicing pharmaciststo realize the expertise and professionalcommitment that IV admixturepharmacists contribute to our departments.Schools of pharmacy need toenhance curricula to reflect not onlycurrent but future IV therapy expertisethat health-system pharmacists needto provide. Most importantly, we needto strategically plan for the practiceevolution of pharmacists whose practicesare based in IV admixture services.Could these staff assume oversight ofall IV therapy in terms of monitoringand recommending appropriate therapeuticchanges? Could they coordinatethe development of IV administrationrate databases for intelligent pumpswith their decentralized colleagues andthen monitor overrides? I suspect theycould assume many other activities thatwould validate the expertise they havedeserved. What do you think?