Hi everyone!

I recently received a request from fetal care inquiring about adding injectable lidocaine and ephedrine to the override list for their Pyxis machine. It doesn't seem like there are any emergent concerns w/ regards to any ISMP recommendations. Accordingly, I was wondering if anyone currently has these medications on override and if there are any suggestions as to why it should not be added to the list.

Hope everyone has a Happy New Year!

Joseph Vu, PharmD

The December 3 acute care ISMP Med Safety Alert main article discusses small volume intermittent medications (defined as those < 100 mL) and potential medication loss when run as primary infusions in contrast to secondary infusions.

The article recommends giving these "small volume" medications as secondary infusions.

We are a pediatric institution who has recently decided to try to move away completely from secondary infusions due to multiple errors of the medication not infusing due to failure to open the secondary clamp.

Hello! For patients who refuse to wear an arm band and are unable or unwilling to provide confirmation of 2 identifiers, what do you have in your policies?

Document, and then do you only provide emergency/life sustaining treatment until they agree to arm band or can state identifiers? Ask them sign a waiver (competency issues!)

Thanks!

With the significant on-going shortage of Muri-Lube, we're struggling to find a suitable alternative. Our primary concerns are for lubricating instruments and more importantly for skin grafts.

Looking for anyone who has found a suitable substitute they're willing to share information on.

D.Patrick PharmD
Children's National

With the significant on-going shortage of Muri-Lube, we're struggling to find a suitable alternative. Our primary concerns are for lubricating instruments and more importantly for skin grafts.

Looking for anyone who has found a suitable substitute they're willing to share information on.

D.Patrick PharmD
Children's National

Wondering how folks assure fentanyl patches are actually wasted upon replacement in the hospital setting? Are you entering an associated task for patch removal with a witness observing waste, and running reports as an audit? How do you audit this? We are struggling with this and it seems to be a vulnerable area for diversion. Thanks for any input.

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Julie Botsford

Dear Colleagues:

As a courtesy to Regeneron, I wanted to post their updated Fact Sheet for their casirivimab and imdevimab monoclonal antibodies. The fact sheet is attached and allows for the omission of the requirement to remove the 20 mL from the bag prior to adding the 10 mL of casirivimab and 10 mL of imdevimab.

Hi everyone,

Low Hemoglobin alert implementation:

I am asking to gather information on hospitals that have:

1)Implemented a low hemoglobin alert in their computer system to alert providers or nurses or other clinicians when patient’s hemoglobin drops a certain point

2)I would like to know what are other hospitals doing to prevent initiation of anticoagulant when patient has a low hemoglobin and if so what hemoglobin level does the alert fire

Colleagues--

I am asking for weigh in on whether adult hospitals have:

1) Adopted ASHP's Standardize 4 Safety concentration for dobutamine infusion of 4000 mcg/mL

2) If so, have you seen any issues with running this concentration peripherally?

3) Additionally, do you have any line restrictions for peripheral use of dobutamine 4000 mcg/mL in needle gauge or line location?

Thank you greatly for your insight. Happy holidays!

We monitor staff more extensively after covid vaccine administration if they have a history of anaphylaxis to vaccine/medication. Does any other facility have a more extensive monitoring plan including dispensing any medications (e.g. Epi pen, diphenhydramine)?