{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,17]],"date-time":"2026-03-17T23:32:33Z","timestamp":1773790353879,"version":"3.50.1"},"reference-count":11,"publisher":"Oxford University Press (OUP)","issue":"19","license":[{"start":{"date-parts":[[2024,3,8]],"date-time":"2024-03-08T00:00:00Z","timestamp":1709856000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,9,23]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Purpose<\/jats:title>\n                  <jats:p>Despite national recommendations to standardize infusion concentrations, there is minimal guidance on institution-specific strategies and outcomes related to epidural infusion concentration standardization and optimization. The purpose of this project is to identify the optimal compounded preparation for use in select adult epidural infusions and assess the impact on drug and fluid utilization and cost savings if the designated preparation is adopted.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>A previously validated tool, the VERB (vial, exchange, rate, and bag) analysis, was applied to epidural infusion pump administration data to identify preparations optimized for efficient supply and resource utilization at a large academic medical center.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Weighing all components of the VERB analysis, the preferred preparation of hydromorphone and bupivacaine for the hospital site was hydromorphone (10 \u00b5g\/mL) and bupivacaine (0.125%) in 50 mL of 0.9% sodium chloride injection (2,500 \u00b5g of hydromorphone per epidural). The preferred preparation of fentanyl and bupivacaine was fentanyl (2 \u00b5g\/mL) and bupivacaine (0.0625%) in 50 mL of 0.9% sodium chloride injection (100 \u00b5g of fentanyl per epidural). Both recommendations are different from the currently utilized preparations at the study site.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>Analyzing historic drug administration data using the novel 4-step VERB analysis identified optimized drug preparations and fluid bag sizes for the most-prescribed epidural drug combinations at the hospital study site.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ajhp\/zxae057","type":"journal-article","created":{"date-parts":[[2024,3,8]],"date-time":"2024-03-08T18:29:52Z","timestamp":1709922592000},"page":"e611-e619","source":"Crossref","is-referenced-by-count":2,"title":["Development of optimized adult epidural infusion preparations to reduce waste and improve operational efficiency"],"prefix":"10.1093","volume":"81","author":[{"given":"Kathrine","family":"Donnowitz","sequence":"first","affiliation":[{"name":"UNC Health , Chapel Hill, NC , USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stephen F","family":"Eckel","sequence":"additional","affiliation":[{"name":"UNC Eshelman School of Pharmacy, Chapel Hill, NC, and UNC Medical Center , Chapel Hill, NC , USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2024,3,8]]},"reference":[{"key":"2024092319515363400_CIT0001","doi-asserted-by":"crossref","first-page":"l4185","DOI":"10.1136\/bmj.l4185","article-title":"Prevalence, severity, and nature of preventable patient harm across medical care settings: systematic review and meta-analysis","volume":"366","author":"Panagioti","year":"2019","journal-title":"BMJ"},{"issue":"7","key":"2024092319515363400_CIT0002","doi-asserted-by":"crossref","first-page":"458","DOI":"10.2146\/ajhp160998","article-title":"Standardizing i.v. infusion concentrations: the time has come","volume":"74","author":"Pasko","year":"2017","journal-title":"Am J Health-Syst Pharm"},{"issue":"22","key":"2024092319515363400_CIT0003","doi-asserted-by":"crossref","first-page":"2176","DOI":"10.2146\/ajhp110001","article-title":"Standardizing i.v. infusion concentrations: national survey results","volume":"68","author":"Phillips","year":"2011","journal-title":"Am J Health-Syst Pharm"},{"key":"2024092319515363400_CIT0004","author":"American Society of Health-System Pharmacists","year":"2020"},{"key":"2024092319515363400_CIT0005","author":"Institute for Safe Medication Practices","year":"2018"},{"issue":"1","key":"2024092319515363400_CIT0006","doi-asserted-by":"crossref","first-page":"92","DOI":"10.1177\/175114370700800134","article-title":"A Survey to inform standardisation of intravenous medication concentrations in critical care","volume":"8","author":"Borthwick","year":"2007","journal-title":"J Intensive Care Soc"},{"issue":"18","key":"2024092319515363400_CIT0007","doi-asserted-by":"crossref","first-page":"1497","DOI":"10.1093\/ajhp\/zxaa199","article-title":"Using intravenous pump infusion data to optimize continuous infusion concentrations and reduce drug and fluid waste","volume":"77","author":"Forshay","year":"2020","journal-title":"Am J Health-Syst Pharm"},{"issue":"13","key":"2024092319515363400_CIT0008","doi-asserted-by":"crossref","first-page":"1238","DOI":"10.1093\/ajhp\/zxab153","article-title":"A single-center cost analysis assessing a change in vasopressin formulation","volume":"78","author":"Kelly","year":"2021","journal-title":"Am J Health-Syst Pharm"},{"issue":"1","key":"2024092319515363400_CIT0009","doi-asserted-by":"crossref","first-page":"e21","DOI":"10.1542\/peds.2004-2452","article-title":"Standard drug concentrations and smart-pump technology reduce continuous-medication-infusion errors in pediatric patients","volume":"116","author":"Larsen","year":"2005","journal-title":"Pediatrics"},{"key":"2024092319515363400_CIT0010","article-title":"Trissel\u2019s 2 Clinical Pharmaceutics Database [proprietary data]. 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