Hello all,

1) Do you allow TPN rate changes after the TPN is initially ordered?
a. If yes, do you allow the TPN rate to be increased from the initial rate, or do you only allow rate decreases?
b. If you allow rate increases, do you outsource TPNs to a compounding pharmacy vs. compound TPNs in house to facilitate dispensing additional bags as needed when the rate is increased above the initial order and dispensed bag?
c. Is the rate change made by directly modifying the TPN order vs. on a separate order (e.g. nursing communication or other)?

We are reviewing our processes for compounded sterile products (CSPs) prepared by pharmacy that come out of our CPM. Our goal is to ensure these products are never inadvertently sent to a patient care unit.

Could you share how your organization manages this workflow? Specifically:

Do you have system-level safeguards (e.g., Epic configuration, barcode restrictions)?
Are there physical or labeling controls in place?
How do you handle staff education and verification steps?

Any best practices or lessons learned would be greatly appreciated.

Good afternoon!

For facilities that have achieved a 95% utilization of your smart pump library, what interventions did you utilize to encourage use of drug/fluid files vs using a basic infusion mode on your smart pumps?

What stakeholders were involved in the project and who led the initiative?
If it required multiple interventions to achieve this goal, was there an intervention that had a larger impact that you would recommend as an initial starting point?

My 154 bed regional hospital is working on reviewing the KIDs list and comparing it to our local formulary. Does anyone have a best practice on how to continually review for the inappropriate excipients for our pediatric (mainly neonatal) population? Thank you!

Morgan Drew Greutman, Pharm.D., BCPS
Clinical Pharmacy Specialist
morgan.greutman@lifepointhealth.net

My 154 bed regional hospital is working on reviewing the KIDs list and comparing it to our local formulary. Does anyone have a best practice on how to continually review for the inappropriate excipients for our pediatric (mainly neonatal) population? Thank you!

Morgan Drew Greutman, Pharm.D., BCPS
Clinical Pharmacy Specialist
morgan.greutman@lifepointhealth.net

Hi Everyone,
Wondering if any of you have been successful in implementing a reliable process to ensure that any patient with an insulin pump PTA has the appropriate monitoring and insulin regimen on board (whether or not the pump is continued). Especially for patients who are undergoing procedures, and/or there are a lot of handoffs and transitions of care, I would be really grateful if anyone could share their processes and how your pharmacists are involved in the care. Thank you! Alex

we use a common vial that is located in the Omnicell.
The nurses are pulling the insulin doses up in the medication room, returning to the Omnicell. However, the label printed on the Omnicell printer is too big- the nurses are complaining that the insulin syringe is covered with that label - making it unsafe for the insulin unit reading when in the room. How are your nurses handling the labeling ?

Hi-
We are in the process of creating an IM Mag kit for eclampsia and have come across the issue of how to administer the 10 gram dose. All sources says 5 gram per buttocks which would be 10 mL on each side, but they don't further detail how many injection sites are used. Has anyone been able to get away with just two injection sites or are you having them further subdivide each 5 gram/10 mL dose into multiple sites?

Also, do you have them mix with lidocaine or just administer straight? I'm thinking the admixing on the floor may make this too complicated.

Hi-
We are in the process of creating an IM Mag kit for eclampsia and have come across the issue of how to administer the 10 gram dose. All sources says 5 gram per buttocks which would be 10 mL on each side, but they don't further detail how many injection sites are used. Has anyone been able to get away with just two injection sites or are you having them further subdivide each 5 gram/10 mL dose into multiple sites?

Also, do you have them mix with lidocaine or just administer straight? I'm thinking the admixing on the floor may make this too complicated.

Hi All,

Hoping to gain some insight on what is being done at other hospitals regarding the use of heparin infusion post-procedure. We use Meditech expanse EMR, but happy to hear about workflow using other EMRs.

At my site, we're seeing issues where heparin is not being resumed after a procedure. Our heparin protocol is nursing driven, and nursing has a protocol for holding heparin prior to IR procedures only.

1. When heparin is placed on "hold" in the MAR, who is responsible for resuming heparin after a procedure?