PC2052: Addressing Interoperability of Compounded Nonsterile Drug Preparation (CNSP) Transmission Across Healthcare Settings to Promote Medication Safety in Pediatric Populations

Purpose/Objectives: Compounded nonsterile drug preparations (CNSPs) lack standardization and are often prescribed through free-text e-prescribing (eRX), which can lead to unintended interpretations by the recipient and subsequently, alterations in drug dosing, preparation, and dispensing. These potential medication errors place vulnerable populations at risk, especially pediatric patients. The United States Pharmacopeia (USP) Expert Panel on the Exchange of Compounded Drug Preparation Information in Health IT (HIT) Systems is focused on proposing a set of encoding rules that would govern how CNSPs are digitized and exchanged within patient electronic health records (EHR), pharmacy systems, eRx, and other HIT systems from prescription initiation to reimbursement. Through better understanding of the challenges faced by those involved within each step of CNSP metadata transmission, USP aims to develop standards that ensure safe, high-quality, and personalized medications for vulnerable pediatric populations.

Design/Methods: A national online survey was created to identify and understand the information needs of health professionals whose work involves CNSPs. The survey was approximately 20 minutes long and was open for 60 days between September and November 2019. The survey was available to six respondent types (pharmacist, pharmacy technician, physicians, nurse practitioners/physician assistants, nurses, and pharmacy informaticists) across seven settings (adult hospitals, pediatric hospitals, skilled nursing facilities, long-term acute care, long-term care, home health, physician office/clinic, compounding pharmacy, and retail/community pharmacy). Survey questions varied in type, including multiple choice, short answer, and satisfaction scoring. Only complete responses from those that met inclusion criteria were analyzed.

Results: A total of 195 respondents completed the survey between September and November 2019. Between 40-71% of respondents identified urgent need for standardization of CNSP data across healthcare settings. Three key needs in the current management of pediatric CNSPs were identified, including the need to create semantically interoperable data standards to support the complete transmission of CNSPs, the need to derive a set of data standards that would facilitate the safe transmission of CNSPs across the continuum of care (from prescription initiation to reimbursement), and the need to create a prototype clinical formulation identifiers (CF-ID) to function as a national standard formulation code. The lowest satisfaction scores reported regarded ability to track patient outcomes, standardized billing elements, and the current computer system’s ability to accept interoperable codes for active ingredients. Challenges to ensure CNSPs are administered as prescribed vary, with availability, insurance, cost, time, and the ability of the pharmacy to properly compound all playing a role.

Conclusion/Discussion: Survey results revealed significant unmet needs to improve the standardization and transferability of CNSP data between health care settings, especially in pediatric populations. The USP has promoted medication safety and quality for over 200 years, and expand those pursuits through the standardization of CNSP quality and safety measures within EHRs.