Hello everyone,

We recently had an issue where a provider used our usual bronch order set to order prn fentanyl and midazolam:

- Fentanyl 25mcg iv Q3min PRN for moderate sedation (only as directed by physician)
- Midazolam 1mg iv q2min PRN for moderate sedation only as directed by physician)

This procedure was done on an ICU unit. Since this wasn't actually done in a designated periop area, it was a nurse who was administering the medications (not a provider), but these were documented in OpTime and not on the MAR under their respective orders.

I'm looking to see if anyone has had errors in which Exparel is being given pre-op and then receiving a subsequent dose during the procedure or at closure. Specifically targeting patients who may have received the max 20mL (266mg) already, and then received a duplicate 20 mL plus standard bupivacaine.

If you have, what have you done to prevent subsequent errors? Do you have CDS alerts, etc in place or physical barriers? We are utilizing Epic and looking for input on better optimization. Thanks!