1. If you have a subcutaneous hydration policy can you share it
2. For those institutions that perform subcutaneous hydration what brand of hyaluronidase do you use and do you use it in peds as well?

Hello!

We had an event recently where nursing forgot to restart a heparin infusion after stopping for 1 hour per protocol in response to an elevated Anti-factor Xa level. Our workflow relies on nurses having to remember to restart the infusion in these situations. We use Epic, so there are reminders they can set, but apparently this tool is rarely used. Wondering if anyone has a more resilient workflow for this that they would like to share.

Thank you!

For sites that have gone live with IV pump/EHR interoperability:

Can you share how the Sepsis fluid bolus is entered in your EHR system?
Currently our rate exceeds 999 mL/hr which would exclude this entry from integration. We want to use integration so that the fluid documentation goes to the flow sheets. If this is an outlier to integration, nursing may forget to document the I&O volume.

How is everyone managing the D-50 shortage? We are critical low and considering offering alternatives or compounding syringes utilizing D70 since that is all that is available. Have any of you compounded using D70? Would you be willing to share your procedure and dating? Thanks!

Hello everyone,

I am curious to learn more about policies/processes involved with Medication History/Inventory in systems with both ambulatory medical offices and inpatient facilities using the same EHR.

What we are currently challenged with is the very different approach these two care areas tend to require (see example below).

This really complicates maintaining a clean medication list as orders must be continually reconciled from split line items to singular orders and vice versa.

Hi All,

When sending outpatient chemotherapy prescriptions, do any of your institutions require an attending and/or chemotherapy authorized prescriber signature (i.e. a second signature if prescription was originally written by a resident)?

Thanks,
Courtney

Courtney Doellner (Carroll), PharmD, BCPPS
Clinical Pharmacy Specialist – Pediatric Medication Safety Officer
cacourtn@med.umich.edu

Are there any institutions that permit range orders for PRN medications? More specifically, ranges in dose (not frequency). If so, how are these range orders interpreted when it comes to times of administration?

For example, if a patient is prescribed oxycodone 5-10 mg PO q6 hours PRN pain, the patient is administered one dose of oxycodone 5 mg at 0900 and then another dose of 5 mg at 1200 because their pain is not controlled, when can they be administered another dose of oxycodone? Is it from the first dose of administration or from the last dose administered?

For those who have Lumason on your formulary for ECHO - what is your policy for pregnant patients or females of child-bearing age?

We added Lumason to our formulary about a year ago and did not specifically address this population. While we are doing a thorough literature search to evaluate risks vs benefits, I thought I would see if others have addressed this. Thank you for your time.

Carol

Hello!

Do any sites have best practices for alternatives to barcode scanning of a patient's identification wristband prior to medication administration in order to perform barcode medication administration (BCMA)? There are some special patient populations, including patients in behavioral health, who need safe alternatives to patient identification wristbands. What highly-reliable alternatives have you observed that can help ensure that the right medications are administered to the correct patient in the absence of a patient identification wristband?

How is everyone else setting up their REMS programs?

Do you have specified people who have a delineation of roles (ensuring that all aspects are incorporated, education, auditing, electronic rules, etc.)? I'm looking to set something up that can become hardwired and not reliant on periodic audits.

Thank you,
Joel