AQUADOSE

• It is important to make sure that you have selected the RIGHT PRODUCT in the RIGHT CONCENTRATION and AMOUNT.
• Check the Name and Strength on the product you have selected from the shelf with the Name and Strength on the label to make sure that you are preparing to mix the right product.
• Check the volume of water required to be added, which is listed on the bottle label.
• Many pharmacists prefer to verify/check the entire prescription before the suspension is reconstituted. This can help avoid wasting a reconstituted medicine if it is later found the patient needs a different product (e.g., wrong strength selected, patient allergy detected, etc).

• Most pharmacies use distilled or purified water to reconstitute powders for suspension.
• Water from the tap has fluoride and other contaminants that may not be desirable.
• Because you have the AquaDose system, you will scan the product; check the volume required for dilution is correct, then dilute.
• A log of all dilutions is retained so you or the supervising pharmacist can verify the volume of water added at any time.
• If you have downloaded this guide for use without the AquaDose system you will need to be especially careful when measuring the amount of water to be added, be sure to use a measuring device that is the appropriate size. For example, a 250 mL graduated cylinder should not be used to measure 10 mL of water. Use the measuring device that is closest in size to the amount of water you need for the best accuracy.

• Tap and invert the bottle a few times so that all of the powder flows freely. Neglecting to do this may trap the powder at the bottom of the bottle.
• Aquadose will add the exact amount of the total amount of water for reconstitution. Shake the bottle vigorously to suspend the powder. Make sure to invert the bottle several times when mixing to ensure that powder adhering to the bottom of the bottle is mixed well.
• Tap the bottom of the bottle firmly on the bench and shake vigorously again.

Most paediatric suspensions don’t come with overly accurate measuring devices. So it’s a good idea to dispense a measuring device, like an oral syringe, with every paediatric suspension dispensed. If your pharmacy has these available for patients, be sure to include one with each paediatric suspension that you prepare. Some pharmacies also include a “stopper” that is inserted into the opening of the pharmacy bottle to make it easier to measure a dose with an oral syringe. These devices block the entire opening of the bottle except for a small hole in which the oral syringe can be inserted. Medication can then be drawn up directly from an inverted bottle by the caregiver. The BMJ has an article that outlined the inaccuracy of packaged measures stating that “While whole spoonful dosing was relatively accurate, the median drug content determined for the ¼ and ½ marks on the measuring spoons provided with amoxicillin suspensions was 148% and 132% respectively.” Article can be accessed here.

• Most antibiotic prescriptions are only stable for a few days or a week after they are reconstituted.
• Check the stability information on the bottle if a patient is being treated for an extended period of time to ensure that the mixed antibiotic will be good for the duration of treatment. For example, a child with a recurrent or hard to treat ear infection may need to take amoxicillin for 21 days, but the suspension is generally only stable for 14 days after mixing. In cases like these, a parent may need to pick up a partial prescription for a paediatric suspension and reconstitute it at a later time. Or, they may pick up the entire prescription in portions (e.g., one week at a time) to make sure that the mixed suspension is stable for the entire treatment time. Ask your pharmacist for direction, or if there’s a policy that dictates what you should do, when these situations come up.

AquaDose will make it very easy and simple for your pharmacy to reconstitute paediatric suspensions only until someone comes to pick up the prescription, consider storing filled prescriptions for paediatric suspensions in a separate area and labeling them “NEED TO MIX” in large letters. Some pharmacies also add a coloured sticker or highlight these letters to make them very noticeable. That way, it’s less likely that an UNRECONSTITUTED suspension will be dispensed. For one last check, when you’re ringing up a customer, take the bottle out of the bag and make sure that it’s reconstituted.