Would anyone be willing to share your current workflow and/or policies on the administration of IV push regular insulin? Does pharmacy draw up all IV Push orders for regular insulin and dilute to "X" ml in a luer lock syringe? Do you allow the nurses on the floors to draw doses up and expect them to dilute the dose or flush after administration? Any info is appreciated! Thanks!

Heather Queen
Medication Safety Pharmacist
heatherq@fmchealth.org

Does anyone have a policy or guideline for how they are using closed-loop insulin pumps and how they are charting them in EPIC?

Is anyone willing to share their oxytocin orders that include compliant titration parameters and goals?

ISMP best practice 8b states "Maintain a 95% or greater compliance rate for the use of dose error-reduction systems".

1. Has your organization achieved the 95% goal? If not, what is your guardrail compliance?

2. If using Alaris pumps do you use "guardrail compliance", "total suite usage guardrail compliance", or unknown?

3. Are you currently live with pump interoperability?

Thank you!

Good Morning!

What morphine product does your organization stock in ADCs in the pediatric setting?

Thank you!

We have recognized for a long time that in patients with enteral tubes, often times the orders are not updated to specify "per enteral tube" but remain as "po". The pharmacy team verifying orders do not know that meds are being given via tube and thus are often not able to identify problems proactively. We recently had a serious safety event related to Flomax being opened and placed into a G-tube, which resulted in a clogged tube and necessitating replacement of the tube twice, the second time under sedation (thus the severity rating of the event).

We have recognized for a long time that in patients with enteral tubes, often times the orders are not updated to specify "per enteral tube" but remain as "po". The pharmacy team verifying orders do not know that meds are being given via tube and thus are often not able to identify problems proactively. We recently had a serious safety event related to Flomax being opened and placed into a G-tube, which resulted in a clogged tube and necessitating replacement of the tube twice, the second time under sedation (thus the severity rating of the event).

Good afternoon,
Wanting to pick the brain of this group for how you are all achieving ISMP Best Practice #16 part C "Monitor ADC overrides and verify appropriateness, transcription of orders, and documentation of administration."

We perform an annual review of our override list and keep it targeted towards only medications needed in an emergent situation. We also have really honed in on reducing the numbers of unlinked override pulls and saw great improvement in those numbers.

Hello,
I was looking to get an idea of how many facilities that use Epic also use the One Step Med process for anesthesia, codes, etc.? Could you please comment on if you use the One Step Med process? Thanks.

Hi All !

How many high alert medications are on your policy for high alert medications ?
How many of those require double checks by nursing ?

I know this is an age old process and topic ! thank you for any information !