We have experienced a recent uptick in amiodarone extravasations. We currently do not require central line for administration. Hoping to get a few responses on whether or not central access is required at any institutions. Or other safety mechanisms in place to improve safety of administration via peripheral access. We do have a handful of ivWatch devices but likely not enough to cover all patients receiving amiodarone infusions.

Hello all,

We usually try to find good stability indicating studies (like stability indicating HPLC studies) to extend our compounded preparations (still within USP 797 BUD limit). For some reason we are unable to find anything other that stability studies according to measured PH and co2 levels...does anyone know if this is considered sufficient? if so, why? wouldn't this be only potency indicating, but stability indicating? I appreciate your help!

Thanks!

Hi everyone,

Our pediatric hospital has an epidural order set that has standard concentrations of each ingredient (we use ropivicaine or bupivicaine +/- clonidine +/- fentanyl/ hydromorphone). The dose field in Epic is mL/hr.

A new MDA expressed that dosing in mL/hr is difficult, and they prefer to dose in mg/kg/hr or mg/hr. We are unsure how this would work with multiple ingredients, each of which has a standard concentration.

How does your facility dose epidurals?

Thank you!

Hi,

We are in the process of expanding our Epic/Alaris interoperability as much as possible. Right now, ED, PACU, and OR are out of scope. We have a plan to go live in the ED, but we were wondering if anyone uses interoperability in the OR/with anesthesia?
Our anesthesia team uses OpTime and one-step meds, so I'm not sure if that is something we can overcome or not.

If anyone has figured this out, I'd love to hear about your processes!

Thank you,
Kara Thornton
UVA Health
krp4h@uvahealth.org

Has anyone else had any recent issues with finding misc floaters in baxter IV bags, specifically NS 100ml and 250ml bags? We recently discovered some misc floaters that we do not believe came from our compounding process or technique. One was a light blue floater and the other was clear/white but seemed to be adhered to the side of the bag and did not fall off when bag was manipulated. WE will contact Baxter to see if they have had any recent complaints,but wanted to reach out to some others as well.

Hello,

I would like to know for organization implementing USP 800, are you classifying Hazardous Drugs based on NIOSH 2020 or NIOSH 2016?

USP 800 recommends to classify Hazardous Drugs based on NIOSH List. There are two NIOSH lists. NIOSH 2020 provides the better practice compared to NIOSH 2016, but has not become official.

Thank you in advance.

Has anyone been able to develop computerized decision support for food dyes and medication orders in the EMR? We recently had a near-miss event with a patient with known allergy to Yellow 5 (anaphylaxis), so are looking for more automated decision support to alert the prescriber and the pharmacist regarding food dye content within medications. In our case, the allergy was properly documented, but no alert was triggered when ordering/verifying a medication containing food dye. I would love to learn from others regarding safety nets around this.

For those at hospitals that do not have 24/7 pharmacy coverage, what do your nurses do for new compounded products after hours? For the most part our EHR tells the nurses how to mix IVs if it is something that needs to be compounded. However, there are cases where there is downtime or the mixture is urgent and they are requesting a paper document telling them how to make everything just in case. If anyone else is providing something like this, would you be willing to share? Thank you!

Hi all,

Would anyone be willing to share their existing DKA/HHS protocol? Our current algorithm seems to confuse nursing staff so I'm wondering which areas we can improve on/clarify to prevent more hypoglycemic events. Of note, we work with Meditech and have considered purchasing Glucostabilizer to integrate with our EHR. Any insights/feedback on Glucostabilizer would be appreciated as well.

Thanks everyone!
Shirley