The Underappreciated Risks of Hospital IV Compounding

A typical hospital room can be described as a patient lying in a bed with an IV drip bag hanging from a pole. But when you take a closer look at IV administration of fluids and medications, it is so much more than a common task. What can be viewed as an uneventful procedure, even by  health-care professionals, is too often accompanied by major errors.

Studies have shown that traditional manual IV compounding process has an average error rate of 9%.1 Despite recent advances, such as “smart” infusion pumps, the health-care industry is still combatting IV compounding errors.

To appreciate the errors that might occur in IV compounding, it’s important to understand what happens before an Prasanna ParthasarathyIV preparation reaches the patient. There are upwards of 30 steps that need to occur, starting when a doctor writes a prescription. That prescription is then sent to a hospital pharmacist working in a compounding center, which is where the process of mixing the medication begins. Many times, this work is not standardized and varies from pharmacist to pharmacist. Considering the busy workload in a pharmacy, even the most conscientious professional is not immune to human error.

The process is largely manual, and one critical step involves measuring the amount of the active ingredient(s) by drawing the fluid up into a syringe and eyeballing the amount on the small black lines. That technique may be sufficient and appropriate for certain medications, but when dealing with chemotherapy or pediatric care, even relatively small errors can lead to serious consequences and the potential for harm becomes significant.

Fortunately, hospitals are becoming increasingly aware of these risks, and IV workflow solutions are gaining momentum in the industry. In the past few years, there has been a surge in IV compounding technology that can help sharply reduce or even eliminate the most common mistakes that still plague the IV preparation process. New technology helps guarantee that when an IV bag or chemotherapy treatment arrives at the patient’s bedside, it contains the proper amount of prescribed medication with no outdated ingredients.

Hospitals are increasingly recognizing the important role IV workflow solutions can play in delivering quality health care. KLAS, a Utah-based health informatics research company, reported that 80% of their respondents believe that IV compounding is the area at greatest risk for making IV medication errors.2 However, technology can cut IV error rates dramatically. According to MD Anderson Cancer Center, their IV workflow solution increased the error detection rate 74-fold.3 Professional and regulatory bodies, such as the Institute for Safe Medication Processes (ISMP) now push for these systems. A medication safety specialist with ISMP recently stated, “Hospital leadership must support the acquisition of IV admixture technologies that incorporate barcoding and safety features like gravimetric.”4

Implementation of these systems is gravely needed. The issue of  IV compounding errors needs a hands-on approach from health-care professionals, with hospitals adopting systems that are proven to increase the accuracy of one of their most important processes. Procedures that might once have been “good enough” are being replaced by technology that delivers a far higher standard of care, something that should be a source of comfort for both hospitals and the patients whose health they are entrusted with.


1. Institute for Safe Medical Practices. Proceedings from the ISMP Sterile Preparation Compounding Safety Summit for SAFE Preparation of Sterile Compounds. 2013: Available at
2. KLAS. IV robots & workflow management systems, is it time to adopt? November 2014:3.
3. Reece KM. Implementation and evaluation of a gravimetric IV workflow software system in an oncology ambulatory care pharmacy. Am J Health-Syst Pharm. 73(3); 165-173.
4. Anesthesiology News. Making the switch to IV workflow. Anesthes News. Dec. 27, 2016. Available at Accessed April 27, 2017.

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