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5PSQ-138 Best practice of ward-based reconstitution in paediatric hospitals
  1. P Nydert1,
  2. M Carlsson2,
  3. A Folkesson3,
  4. A Hardmeier4,
  5. L Johannesson5,
  6. P Kinderlöv6,
  7. L Morota1,
  8. M Paulsson7,
  9. L Rafelt5,
  10. K Widell8,
  11. S Lindemalm4
  1. 1Karolinska University Hospital, Neonatal Department, Stockholm, Sweden
  2. 2Lund University Hospital, Neonatal Department, Lund, Sweden
  3. 3Falun Hospital, Paediatric Department, Falun, Sweden
  4. 4Karolinska University Hospital, Paediatric Department, Stockholm, Sweden
  5. 5Linköping University Hospital, Neonatal Department, Linköping, Sweden
  6. 6Sahlgrenska University Hospital, Paediatric Department, Gothenburg, Sweden
  7. 7Akademiska University Hospital, Paediatric Department, Uppsala, Sweden
  8. 8Akademiska University Hospital, Neonatal Department, Uppsala, Sweden


Background In our country, we use a national system for paediatric drug data management called ePed.1 It provides a unique identifier (ePed-ID) for each reconstitution connected to the national drug-ID. This system also contains a full description for the reconstitution with e.g. administration time, shelf-life, common indication/dose, a dose range check and references.

Purpose This study investigates additional risk classification and best practice video instructions to each unique ePed-ID, with vancomycin as an example.

Material and methods With regards to vancomycin, this study consists of:

  • High–risk classification developed by the European Directorate for the Quality of Medicines and Healthcare (EDQM).2

  • Use of video recording to assess reconstitution in six different paediatric settings.

  • Identification of best practice by the Delphi process.

  • Recording of professional videos for instruction purposes.

Results Six major paediatric centres contributed to the investigation. All hospitals use vancomycin in standard concentration 5 mg/mL and it is commonly regarded as a high-risk drug due to a multistep reconstitution practice. In the risk evaluation, two centres used pre-diluted vancomycin to lower the residual risk. Four centres used closed-systems, and three centres added risk-reducing strategies from a hood or forced ventilation. By observing the recorded videos, different strategies were present, e.g. additional protective clothing and processes in centres with non-validated closed systems. The Delphi process had a 100% agreement for best practice depending on the risk assessment, resulting in three videos for instruction purposes regarding vancomycin:

  • Pharmacy prepared.

  • Validated closed–system reconstitution with minimal recommendation of protective clothing.

  • Non–validated closed–system reconstitution with recommendation of protective clothing and forced ventilation.

Conclusion High-risk drugs identified by the EDQM resolution allows hospitals to act differently. The residual risk of high-risk drug reconstitution can be captured by video imaging, to better understand the process of reconstitution. This method will be used in a national project for all instructions in the ePed database to provide risk classification and record video instructions.

References and/or Acknowledgements 1.

2. EDQM, Resolution CM/Res(2016)2 On Good Reconstitution Practices in Health-Care Establishments.

3. Financial support from The Swedish National Pharmaceutical Strategy

No conflict of interest

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