The Impact of Intravenous Fluid Plus Electrolyte Standardization on Technician Workload at a Comprehensive Cancer Center

Purpose: Upon initial review of institutional practice over a 6-month period, it was determined that when utilizing an ordering tool within the electronic health record (EHR) for an intravenous (IV) fluid plus electrolyte(s), there were 606 various combinations that were compounded by technicians in the inpatient pharmacy setting. Variability in compounds have led to challenges in reusing returned doses, leading to an institutional initiative to standardize the options within an electronic ordering tool for an intravenous fluid plus electrolyte(s). The purpose of this study was to determine the impact of intravenous fluid plus electrolyte(s) standardization on pharmacy technician workload.

Methods: This pre- and post-implementation study included pre-data over a 6-month period (August 2018 – January 2019) and compared it to data 1-month post implementation (February 8, 2019 – March 8, 2019). Data was to be presented in weekly divisions of the months studied. The primary objective was to determine if a relationship exists between the percentage of weekly compounded doses and the number of weekly variable compounded fluid plus electrolyte combinations. The secondary objective was to assess the impact of the standardization on pharmacy technician workload.

Results: Data was presented as a percentage of the number of weekly compounded doses to total number of dispenses (compounded plus non-compounded doses) alongside the number of weekly variable compounded dose combinations. Descriptive statistics show that the mean percentage of weekly compounded doses was 0.67 (67%) and 0.39 (39%) over the pre- and post-implementation period, respectively. The mean number of weekly variable combinations was 38 and 18 over the pre- and post-implementation period, respectively. A linear regression showed statistical significance between the percentage of weekly compounded doses and the number of weekly variable compounded combinations (p<0.001). The mean number of doses compounded per week was 680 and 248 over the pre- and post-implementation period, respectively. Utilizing 5 minutes as the institutionally accepted metric for time to compound one dose, the pre- and post-implementation data shows a mean weekly compounding time of 3,400 minutes (57 hours) and 1,240 minutes (21 hours), respectively.

Conclusion: Standardization of the options within an electronic ordering tool for intravenous fluid plus electrolyte(s) resulted in a smaller percent of compounded doses, saving a mean of 36 hours/week, translating to 0.9 full-time equivalent (FTE) per week that may be re-allocated.