Nix the Six: Raise the Bar on Medication Delivery

When compared with adults, pediatric and neonatal populations historically have significantly higher rates of medication errors. Recent driving forces have focused efforts on standardizing the medication delivery and dosing for this population. The Institute for Safe Medication Practice has drawn a strong correlation relating nonstandard injectable drug concentrations and increased medication errors. There are currently two methods of compounding continuous infusions for neonates: the Rule of Six, a method that uses the patient weight to calculate the concentration, and the Standardized Concentration method, where the concentration remains stable and the rate of infusion varies. Few issues have generated more controversy for neonatal healthcare practitioners than the mandate to limit and standardize available drug concentrations eliminating the Rule of Six. This article will provide an overview of the issue, exploring the advantages and disadvantages of both compounding methods, as well as describe current regulations and guidelines, available evidence, and resources available. The process for implementing standardized drug concentrations will also be discussed.