Anyone willing to share their organization's policy on maintaining medication fridges?

1) How frequently are they cleaned?
2) Who cleans?
3) Is that individual different in ambulatory areas vs acute care areas?
4) What all does the cleaning entail?

Thanks,
Sloane Hoefer
Nebraska Medicine

We are a large institution that serves both adult and pediatric populations. There are several injectable medications that are used off-label and given via inhalation (given by respiratory therapy).

How are other institutions dispensing these medications for use? Do you draw them up in patient specific doses or do you dispense products as a unit dose vial and allow respiratory therapy to draw up the dose and administer? If you are drawing them up, how are you sending them to avoid administration via the wrong route (Intravenous)?

For 340B hospitals:

How are you dispensing misoprostol 25mcg for cervical ripening? Since it is hazardous, are you splitting and packaging in the pharmacy or are nurses cutting a 100mcg tablet on the floor?

Since it is off-label, I don't anticipate a 25mcg product ever becoming available.

Seeking input from other institution's policies and hardwired safeguards regarding early administration of narcotic PRN medications. Concern that early administration may lead to dose stacking and potential for oversedation/respiratory depression esp in vulnerable populations (opioid-naive, geriatric, etc).

Example: Example: Hydromorphone 0.5 mg ordered q4h PRN. If administered every 3 hours instead of every 4, the patient could receive two additional doses (1 mg) within a 24-hour period.

Hi All

Has anyone had any ADRs associated with IVP venofer? If so, what were the reactions? What have you done to prevent?

Thank you

Does anyone have a good process in their EHR to manage orders for, dispensing of, and documentation of provider administered intra-articular injections on a med-surg unit?
We had a recent scenario where the provider entered the order as IM instead of IA, and the med went to the MAR giving the impression that the nurse was to administer it IM.

Our EPIC Instance reports QTc using Bazett's formula.

Has anyone had success with changing their default QTc formula in EPIC to a different one: Framingham or Fredericcia?

Problem: The Bazett formula is known to overestimate the number of patients with potentially dangerous QT prolongation (overestimates QTc at high HRs, underestimates at low HRs)1. A mean difference of 24 msec between the Bazett and Fridericcia formula (overcorrecting with Bazett) was observed in patients with a heart rate ranging from 80-90 bpm.1

For those using the Alaris IV pump:
-What strategies do you use to ensure accurate PCA pump programming, especially when it comes to concentrated infusions?
-Do you have level of care restrictions for concentrated PCAs?
-Do you use capnography for concentrated PCAs?
-Anything unique or special with the independent clinician verification for concentrated PCAs?

Appreciate your insight,
Stacie Ethington MSN, RN
Nebraska Medicine

Greetings, all.

For vesicant infusions lasting longer than 30 minutes via central line, both ONS and INS recommend assessing blood return at the beginning of the infusion, per organizational policy during, and after infusion. At what frequency are your nurses assessing for blood return during the infusion?

Thanks,
Stacie Ethington MSN, RN
Nebraska Medicine

hi all,
Was wondering if anyone is doing continuous pip/tazo 9 g/13.5 g /18 g in NS for total volume of 240 mL via elastomeric pumps through midline? I'm having a hard time finding any pH / osmolality data supporting use through midline.