Ketamine 100 mg/mL concentration--Changes to storage in kits?

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Donald McKaig
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Ketamine 100 mg/mL concentration--Changes to storage in kits?

Hoping that others could share what (if any) changes have been made for ketamine storage/dispensing in response to a reported fatal medication error. http://vtdigger.org/2015/07/09/patient-death-after-ketamine-overdose-lea...

1. Have you removed ketamine from Omnicell/Pyxis?

2. Have you removed ketamine from emergency kits/intubation trays?

3. If yes, was anything added to the emergency kit/intubation tray as a substitute.

We have removed concentrated ketamine from pediatric intubation kits--but struggling with situation of pediatric patient without IV access who requires intubation and would need to give IM ketamine. Trying to balance safety with ensuring medications needed in emergency/life-threatening situation are available.

Thank you for any feedback on this issue!

Don McKaig, RPh
Pharmacist Specialist, Medication Safety and Quality