Hi all,

Can you share your dual verification practices for a prn controlled substance pump bolus dose from a continuous infusion (non-PCA)? For example, at initial administration, dose change, at shift change, new syringe, change in pump, at every pump bolus administered, etc.

Thank you,
Brennan

We continue to see errors with insulin pump management at my health system, specifically when insulin pumps are removed because a patient is unable to operate during the acute stay. The error is that basal insulin requirements are not met as patients are usually put on only sliding scale as a transition. Re-education has not been successful and since it's a low-occurrence situation we are struggling to come up with a good solution. Does anyone have a good EHR driven (or other) process in place? One idea was to somehow force a 'time-out' but looking for other ideas.

The question relates to the instructions for the ceftriaxone 1 gram vial reconstitution instructions.
The instructions have you instill 2.1 ml of diluent into the 1 gram vial to get a concentration of 350 mg/ml. We have had several Nurses and Pharmacists complete this - each time the average final volume of the vial is 2.4 ml. You would need a final volume of 2.85 ml to get the required concentration.
These instructions are the same across the generic manufacturers of ceftriaxone and we have gotten the same results for more than one generic product and across lot numbers.

A NICU at one of our hospitals brought forward the concern that the 1 ml and 3 ml BD syringes are the same barrel size, so when they are inserted into the pump, the autodetect feature (Alaris syringe pump) cannot tell the difference and the nurse must manually select the syringe size. Due to the label on these smaller syringes, it is often hard to tell which size the syringe actually is.

Apparently mistakes/errors have happened more than once, and I wanted to see if anyone else has had this issue or any successful mitigation strategies?

Thank you

Can we keep open vials or ampoules in IV Hood

Hello,

How does your institution comply with fosphenytoin IV Push administration on the nursing units with regards to NIOSH classification of a hazardous drug.
1. Do you compound the IV Push dosage form in the IV room and send to nurse or
2. do you send vials and allow nurse to draw up in the unit using a CTSD?

We have had some reports of wrong volume preparation for doxorubicin 2 mg/ml IVP syringes caught prior to patient administration. We utilize EPIC's split dose functionality, which includes both the total volume and package volume on the syringe label. Have others had similar reports of incorrect volume in each package? If this is not a problem with your institution, would you be willing to share an example of your split dose doxorubicin label to assist us in improving?

How does your hospital manage the use of sugammadex for patients in emergency situations when intubation and ventilations are unexpectedly difficult or impossible, requiring sugammadex administration in 16 mg/kg for NMBA reversal?

Where is the total reversal dose kept? Crash cart, anesthesia cart, or kit?

Thanks

Hi
I would like to know how your sites ensure patients are ventilated prior to starting propofol/fentanyl/midazolam/paralytics infusions? We use Epic and would like to know if there is a system enhancement to not allow ordering or verification or dispensing of sedation meds to non -ventilated patients?

Thank you
Pratixa Patel

We currently utilize Veri-Link (Rudolph Research Analytical) refractometer in our diversion monitoring program.

Reaching out to inquire if there is any known pooled RI Drug Index reference documents.

Trying to identify found unlabeled syringe contents - wanted to know if any one had knowledge of shared reference document and/ or had in their refs document any medication with a specific RI of our unknown sample reading = 1.33242

Thank you,
Michelle