We're a pediatric hospital and it seems once a year this issue comes up. Many years ago someone built a link in Cerner (patient profiles) to a high-risk dosing calculator. Over the years we've had problems in identifying owners for maintenance and we've recommended not "using" this tool until we can get someone (IT/Informatics) to own maintaining the tool.

Pharmacy has recommended their typical references (such as Lexi) as their check. I believe many of the nurses are using it to double check their own math when dealing with high-risk drugs (ex: opioids, electrolytes, etc).

Hi all,

We recently implemented the use of 503(b) compounded phenylephrine syringes for increased safety in our perioperative settings but are encountering concerns from our Billing team.

They are referencing that CDC and CMS guidelines for SDV's specifically say you cannot share Single Dose Vials (SDV) with multiple patients and because these vials were made from SDV at the compounder we may not be reimbursed for them when used in the Periop/ED settings. Also, that their use could even jeopardize the reimbursement of an entire OR case.

We use BCMA for several items that could be used during diaper changes: zinc oxide (Desitin), nystatin powder, etc.

If you are an organization that does this as well, do you allow CNAs do apply such products during diaper changes? I do worry about scope of practice. Is anyone using a protocol or something similar to allow these non-licensed staff to do this task? If parents are using these products during diaper changes, how do you capture that documentation--back-charting?

Thank you,
Stacie Ethington MSN, RN
Nebraska Medicine

Hi All
We missed this and were caught off guard by the albuterol 20 mg/100 mL shortage. We use this to make our cont nebulizations of albuterol, especially for our pediatric population. Right now we have to open up 40-50 of the 2.5mg/0.5 mL ampules to make the nebs, which is less than ideal and a huge time suck. How are others handling this shortage? Of course it is now back to school and we're getting quite a few kiddos with bronchospasms d/t all the viruses and smoke (fire season here).
Greatly appreciate input!
Thanks
Lindsey

We recently had a potential error where a patient was recieiving mag (20gm/500mL) for pre-eclampsia who was also receiving maintenance fluids (LR) at the same time. The provider instructed nurse to turn of LR as the patient had a high urine output. Nurse was under the impression that magnesium must be infused concurrently with fluids to minimize irritation/infiltration. Our order sets/guidelines do not state this.

Have other institutions encountered this? It doesn't appear to be in any guidelines...is it just a best practice? I have not heard of this practice before.

I am looking for practices that other facilities are doing in regards to the administration of IV push diazepam. The dosing administration instructions and other compatibility references state not to mix with other solutions or use as a continuous infusion and the y-site compatibility info is not clearly defined either. Does anyone else have specific guidelines for diazepam administration at your institution? In particular, doing a slow saline flush after undiluted administration? Diluting to a least a 1:20 ratio as stated has been done(according to Trissel's without precipitation?

We have been using the same modified Del Nido Cardioplegia solution "recipe" for a few years now without incident. Today we had reports from perfusionists that they feel our solutions "aren't working as well". This is the first we've heard of this and the solutions we had analyzed were spot on for active ingredients. As a result, I'd like to see if anyone can share the recipe(s) you use?

Has anyone been cited during a survey for using Silent Knight Pill Crushers on nursing units? Our institution does use the pill sleeves. Was warned recently that these might not be compliant. Has anyone had an issue and what do you use instead?

We are seeing an increased usage of intermittent IV ketamine for non-sedation indications like pain and agitation, especially in our movement disorder patients. Does your site allow nurses to administer intermittent or PRN IV ketamine? If so, what parameters are used to distinguish from mod-deep sedation? Can you share your policy? Thanks! -Melody Sun, CHOC Children's

Does anyone have a process for oral chemo monitoring they would be willing to share? How do your pharmacists or nurses document monitoring? How often do they monitor (daily? weekly?) Do you have any formal oral chemotherapy agent monograph they use to determine monitoring and adjustment parameters or use drug references like lexicomp?

Thank you in advance,
Mara