Anybody have a good process for dispensing non-formulary home meds from a patient's pill pack?

Good morning,

Wondering how other facilities are handling this. We have an orderset for newborns that has hep b vaccine (among a few other things) pre-checked and thus ALWAYS ordered unless provider unchecks which is rare to never. Of course, Hep B administration also requires parental consent to administer. So it could happen that the vaccine is ordered but the parents do not consent. How do other sites handle this? Any information would be helpful.

Thank you,
Lauren Boc

Good morning! We have had several events in which an order was verified for a medication stocked in a dispensing cabinet with a high dose/excessive dose units (e.g. 10 unit-dose oral syringes). I have seen a functionality in Cerner before in which a pharmacist receives a personalized alert when verifying an alert that is dispensing an excessive amount of tablets/syringes/etc. Does anyone have an alert like this built in Epic? If so, what is your threshold for the alert to fire to a pharmacist? Thank you! Jordan Anderson, Driscoll Children's Hospital

We are evaluating our processes for dispensing and storing large-volume fluids containing Potassium Chloride (KCl) and are seeking input from other institutions on the following:

•Are these fluids supplied by pharmacy or central supply at your organization? If your organization uses a mixed approach, do you have a defined potassium chloride (KCl) threshold—such as 20 mEq—where products at or below that cutoff are supplied by central supply, and products above are provided by pharmacy?
•Are these fluids stored in Automated Dispensing Cabinets (ADCs) at your organization?

Hi all - We are working on an adequate sedation during use of iv push paralytics initiative. Does anyone use an intubation checklist with line items for adequate sedation for induction as well as post-intubation? If you are able, I would love to see copies of your checklists as we are looking to revise ours. Thank you in advance!

Lara Ellinger, PharmD, BCPS
(she/her/hers)
Medication Safety Program Manager
Northwestern Memorial HealthCare Quality and Patient Safety
laelling@nm.org

Good Afternoon MSOS Members,

Any site added an ultra short acting, Remimazolam (Byfavo), to the formulary for induction and maintenance of procedural sedation in adults undergoing procedures <30 min (Instead of Propofol)? If so, would you mind sharing your experience?

Thank you,

Manisa

For hospitals with a cath lab, how many staff members are in the room during the procedure? As a high-alert medication, does heparin require dual sign-off when staff are operating under a provider's supervision (i.e. nursing) at your institution? If your institution does not require a dual sign-off, what electronic safety feature(s) do you have in place? For reference, our EHR is Epic, and we are not currently utilizing barcode scanning in the OR.

Dear MSOS colleagues:
I would like to clarify if you keep Concentrated (Undiluted) Magnesium Sulfate 50% vials in the non-cardiac operating rooms automated dispensing cabinets (ADC)
as per the JCI IPSG, (IPSG 03.02), Improve the safety of medications (concentrated electrolytes)
"The exception to store concentrated electrolytes outside pharmacy in patient care units is the availability of magnesium sulfate in the cardiac surgery kit and cardiac surgery locked storage areas, emergency carts and where patients with preeclampsia treated"

Hi

Phytonadione vials and ampules for neonates are significantly cheaper than the preservative-free syringes but contain 4.5 mg of benzyl alcohol per dose.

The American Academy of Pediatrics and the CDC are fine with the minute amount of benzyl alcohol, but our providers are worried about parents refusing the dose because of a perceived danger from the preservative.

Would you mind answering this brief, 2-question survey, so we can get a feel for what other hospitals are doing?