Admelog is not FDA approved for use in Tandem, Medtronic and Beta Bionic insulin pumps. Our formulary insulin lispro is Admelog.

If your organization allows patients to continue their insulin pumps while admitted, do you use Admelog insulin to refill the reservoir if the need arises?

Thanks,
Sloane Hoefer
Nebraska Medicine

I am seeking information on what is required for Independent Double Check for Vasopressors and Vasodilators at your facilities. We are updating our current IDC requirements and have suggestions for IDC to be required for initiation, bag change and handoff for Dopamine, Epinephrine, Isoproterenol, Phenylephrine and Vasopressin, Others have requested IDC initial, bag change, handoff only for Epinephrine and no IDC required for the other infusions.

For weight-based doses of Bicillin that are smaller than the prefilled syringe, are you drawing those up patient-specific or dispensing the full syringe with its original labelling?

The commercial product has a very strong statement that says, “WARNING: FATAL IF GIVEN BY OTHER ROUTES,” which you can see in the photo below. If transferring the patient’s dose to a standard IV syringe for IM administration, we would lose this labeling and increase the risk of inadvertent IV administration.

Hello colleagues,

How do you dispense Lugol's solution when dosed in drops for ORAL use (i.e. thyroid storm)? Do you convert to mL and draw up doses, dispense bottles with droppers? Looking to assure safe dispensing around this rarely used drug.

Thank you,

Megan Fragale, PharmD, MS, BCPS
Medication Safety Officer
Skagit Regional Health

Good morning -
I am looking for input from facilities currently using a low-pressure manifold with a syringe pump (ideally Alaris). We are aware of the FDA alert specifically advising against use of high-pressure manifolds with Alaris, but the ICU Medical manifold appears not to apply in this case. We are evaluating using the ICU Medical manifold with the Alaris syringe module and would love feedback from sites that currently use this setup with success. Have you had any issues with cracking or inadvertent bolusing?

Hello!
I have a question specific to adverse reaction reporting...While reviewing our ADR report, a question came up about reactions reported as elevated INR, or other increased levels. Unlike hyperkalemia, some of these do not have an ICD 10 code as a condition. Another example might be elevated CPK but not associated with rhabdomyolysis or other symptoms.

Do you include elevated levels in your reaction reporting? Specifically, if there is not a clinical symptom associated with it?

Good afternoon,

What strategies have organizations implemented to reduce nursing reliance on muscle memory when selecting products from an automated dispensing cabinet? For example, if historically we have 5 mg oxycodone stocked but are now stocking 10 mg oxycodone in addition to accommodate patients on high doses - there is a concern that a nurse may default to muscle memory and pull 2x 10 mg tablets thinking that they are 5 mg tablets. This of course leads to potential overdose as well as discrepancies from diversion monitoring standpoint.

Good morning, I wondered if anyone was willing to share what items they have put into place to meet and sustain the < 15% target for the concurrent use of Opioids and Benzodiazepine eCQM metric. How are you tackling providers continuing home medications on discharge (not prescribing them, but they still appear on the discharge record). Thanks for any and all feedback!

One of my facilities is drawing up medications to be used for TAP blocks by the physician later in the afternoon. They have (I just learned) begun drawing up BUPivicaine, DEXamethasone, saline, lidocaine, and at time clonidine into separate syringes per the patient weight based order and are labeling and refrigerating them. They have not been labeling with the time the medications are drawn up. They do not have a hood and are using aseptic technique to withdraw into syringes on a clean surface (this is a surgery center).

Hello!

Our Medication Safety team has been tasked with starting a controlled substance diversion program for our healthcare system. I am wondering if anyone has experience implementing a program like this at an organizational level. If you would be willing to share your experience or what applications you utilize within your program, I would appreciate it.

Thank you,
Blake Carley, PharmD
carley.blake@marshfieldclinic.org