I’m seeking insight into how your institutions manage preparation workflows for certain medications, particularly IV agents but also oral. We are evaluating our pediatric satellite pharmacy workflow and trying to balance timely administration with safety and standardization.

For medications such as furosemide IV (usually a no-dilution, straight draw from the vial), do you:
• Link the commercially available product to your ADC for nurses to draw up doses at the point of care?
• If so, are nurses drawing up only measurable, no dilution doses (e.g., ≥ 0.05 mL), and what safeguards do you have in place to ensure accuracy, sterility, labeling, administration, and appropriate beyond use dating?
Alternatively:
• Does your pharmacy prepare and dispense all doses (IV and/or oral) before administration?
• If you use a hybrid model, what criteria determine whether a medication is pharmacy prepared versus nurse drawn?

Any insights, processes, or lessons learned from your institutions would be greatly appreciated.

Natalie Zilban, PharmD., MPH
Jackson Health System