We have received recent concerns about pharmacies incorrectly compounding and dispensing oral solutions of clonidine for pediatric use. When approaching the compounding of this medication, pharmacists and pharmacy technicians should consider the tips outlined in the December 2016 Link article Simple math still needs checking: tips for avoiding medication errors. We also encourage you to review the Institute for Safe Medication Practices (ISMP) Canada Safety Bulletin Oral Clonidine Suspension: 1000-Fold Compounding Errors Cause Harm to Children.
Another great resource to help you put preventative measures in place before problems arise is The Systems Approach to Quality Assurance. Developed by ACP and ISMP, this approach includes learning modules, guidelines, forms, and templates.