We are working on updating our Lipid Rescue kits(used for local anesthetic toxicity) in the Pyxis machines. I am specifically looking for information on whether the use of the 1.2 micron filter tubing is necessary in this situation. Also, if the filter tubing even supports the high rates of infusion(question has been posed to the manufacturer, but no reply yet). Rates of infusion can be more than the Alaris pump max rates of 999ml/hr. Any info and/or suggestions is appreciated!

Can anyone share if you have specific medications, infusion rates, or patient populations that you use microbore tubing over standard macrobore tubing for medication infusions?

If you made a change from macrobore to microbore for any particular medications, were there any safety concerns or events that led to that change?

Thanks in advance!
Dana

We have inconsistencies in dispensing (mostly IV) medications in light-protected bags in accordance to Lexicomp instructions for "Protect from Light." There are some medications that Lexicomp recommends to "Protect from Light" under storage conditions only, and some also includes it under administration. Do you dispense medications in light-protected bags if the recommendation is only mentioned under storage conditions or only if also mentioned under administration? Thank you. -Melody Sun, CHOC Children's

One of our pharmacists found an article regarding daptomycin stability that states that once reconstituted and injected into infusion bags, they can be stored for up to 7 days when stored at 2-8 degrees Celsius ("Stability of daptomycin reconstituted

Currently our health system follows ISMP recommendation of having basal insulin dispensed by pharmacy in a patient-specific barcoded syringe. We have recently upgraded our ADCs that will now print patient specific labels. We use these labels for the sliding scale/correctional fast acting insulin in the ADCs (much better process than old way with pharmacy flag labels).

Hi everyone -

Where does your organization require an administration IDC for infusions - new bag, bag changes, rate changes, etc? We are trying to determine best practices and are curious what other organizations are doing. Thank you!

Liz

Hello! We recently received feedback from a surgeon that a change of brand of oxymetazoline, from AFrin to Sinus Extreme by Vicks, has resulted in an undesirable change in effectiveness. In this case, oxymetazoline was being used in infants, as a hemostatic agent where it is applied on pledgets to mucosa surfaces and the ear canal to vasoconstrict small vessels. Has anyone else received feedback on the effectiveness of Vicks brand oxymetazoline versus Afrin brand?

Does anyone require chain of custody documentation for fentanyl patches at the end of each nursing shift? We recently had an event where an RN noticed a patient's patch was missing. It is unknown how long the patch had been off, or where it went. I was thinking about how we require 2 RNs document the volume of continuous infusions of controlled substances that remain at each change of shift. Should there be some type of acknowledgment each shift that the patch is still there?

Hi all,

Has anyone established a goal timeframe for a certain percentage of your smart pump fleet to download current version of drug library after an update (i.e., 90% of pumps updated after 72 hours)? Also, how frequently do you monitor this metric after a library update and what strategies do you use to help reach/maintain this goal?

Thanks!

Sammy Burton, PharmD, FISMP
Medication Safety Pharmacist – Smart Pumps
Cleveland Clinic
burtons4@ccf.org

Hello,

The Baxter Sigma Spectrum infusion pump has a rate accuracy of +/-5%. Over the course of extended infusions (12-24 hours), a +5% variability can cause the infusion to end up to 2 hours early (entire bag is infused, but over less time). This is a concern for abrupt discontinuation of parenteral nutrition.

If you have experienced this phenomenon, with the Sigma or otherwise, I'd be interested to hear how you have mitigated this. We have discussed increasing overfill for all PN orders or patient-specific PN orders.