Hi all,
We currently have a requirement for telementry monitoring during phenobarbital loading when being used to treat alcohol withdrawal (10-15 mg/kg infused over 30 minutes).

We have had a recent request to remove this requirement.

Does anyone out there allow phenobarbital loading without tele? Would like to hear about your experience.

Thank you!

We are getting requests from our emergency department to use nebulized tranexamic acid for patient's with hempotysis. I was wondering if anyone has experience using nebulized tranexamic acid or if anyone has a protocol or policy for using nebulized tranexamic acid that we could review.

Specifically for neonates, what resource/references do you use to ensure medication compatibility with the additives in TPN. Please share any internal or external references, thank you very much in advance.

For ambulatory locations that have medications but not within an ADC, how do you decide/limit what medications should be stocked in those clinics?
These locations are high risk for errors from medications because of lack of barcode scanning and no ADC to prevent wrong dispense, expired medications, etc.
-Do you have a decision tree to guide what medications are allowed for clinic locations?
-Do you have a committee that decides or is it a single person?

Our system Medication Safety Council has been working on BCMA compliance, and an interesting question has bubbled up involving practices around patient verification when patients decline to wear wristbands. A few of our neurobehavioral health units have come up with some rather "creative" workarounds to scan a patient barcode during medication administration. We don't want to encourage patient scanning just to comply with a metric goal, but rather to increase patient safety by confirming that the correct patient is receiving the medication.

Hi all,

Have a question, especially for institutions that have both peds and adult patients. How do you guys manage partial doses for oral tabs (when no oral solutions) for peds? For example a medication has no oral solution but tabs are available. Currently, since most meds are on ADC, we provide nursing instructions in medication admin instructions to dissolve the tablet to create a solution of a certain concentration and draw up the the specific dose.

Example: "Dissolve 32mg tablet in 5ml, give 3.3ml = 21 mg dose"

This request is posted on behalf of our TPN lead pharmacist....our current central line policy includes the following "Total Parenteral Nutrition (TPN) is administered through a dedicated virgin port or lumen if clinically feasible. Changing the CVAD over a wire to obtain a virgin port is not recommended." Infection Prevention and Nursing leadership are reevaluating "virgin' line due to potential need for placement of a new central line to make a 'virgin" port/lumen available.

What does your TPN and/or central line policy state about IV access for TPN administration?

We are looking to go live with Epic's Dispense Prep and Check in our sterile compounding suite(s) within the next 10 months. Looking for any tips from those who have gone before. Also which vendor did you use for equipment? Are you doing gravimetrics, image based, or a mix? Appreciate any and all insight!

We have noticed a lower incidence of barcode scanning of inhalers that we would like to see.
If you have BCMA how do you scan inhalers on administration-

Do you have the nurse scan the med itself (may require separating canister from inhaler cover each time), or a patient specific label, etc.
And if you use a patient specific label how do you handle it if the dose changes or how do you ensure the label stays attached to the product?

Any other thoughts are welcomed.
Thank you!

Hello Colleagues,

What safeguards to you have in place to alert staff to the presence of an epidural and/or potential concomitant anticoagulant use in a patient with an epidural? Any warnings build in your EHR? Consults to pharmacist upon ordering an epidural?

Thank you,
Megan Fragale, PharmD, MS, BCPS
Medication Safety Officer