New standards for compounding kids’ liquid medicine created by statewide initiative

Michigan will be the first state to standardize concentrations for children’s liquid prescriptions, due to a statewide initiative to reduce pediatric medication errors.

University of Michigan and the Michigan Pharmacists Association have announced the release of the new standards published on mipedscompounds.org as part of a sweeping campaign to educate prescribers and pharmacists in the state and rest of the country.

The move comes after a survey of Michigan pharmacies revealed potential safety risks posed by the lack of standardization of compounded pediatric oral liquids for more than 110 different medications.

In Michigan, more than half of the compounded drugs had at least three different concentrations being compounded by various pharmacies, with some concentration levels up to 30-fold higher than others, according to information collected from more than 200 participating pharmacies. Before the new recommendations, pharmacists were using different concentrations when compounding more than 100 drugs.

The initiative has prompted standard concentrations for nearly 120 drugs that are available on the new mipedscompounds.org website. The drugs on the list range from Adderall (used to treat narcolepsy and attention deficit hyperactivity disorder), to Protonix (used to treat gastroesophageal reflux disease).

“We asked pharmacies and hospitals around the states which drugs they were compounding and came up with this list,” according to project leader James Stevenson, PharmD, FASHP, Chief Pharmacy Officer of the UMHS Pharmacy Services Department and an associate dean at the U-M College of Pharmacy.

“For managed care and hospital decision-makers, their objective is to assure the most safe and effective therapies,” Dr Stevenson said. “We know lack of standardization leads to medication errors in this vulnerable pediatric population. Payers may have a role to help encourage the adoption of these standards.”

“Transitions in sites of care, including movement between the home and the hospital as well as between pharmacies, are associated with patient safety risks, and this may be especially true in the pediatric population because of the number of liquid medicines that must be compounded,” said UMHS Pediatric Associate Chief Medical Officer Chris Dickinson, MD, a coinvestigator on the project.

"It has been gratifying to see this state-wide collaborative effort, and we encourage all prescribers and pharmacists to adopt the standard concentrations in the interest of improving medication safety in our pediatric population.”

The project was supported by a $150,000 grant from FDA. The standards have been endorsed by the Michigan Academy of Physician Assistants, Michigan Health & Hospital Association, Michigan Pharmacist Association, Michigan Osteopathic Association, and the Michigan State Medical Society.

Payers may have a role to help encourage the adoption of these standards.