Recently had a patient requiring high dose/high rate insulin drip. We currently prepare 100 units/100 mL and 500 units/500 mL. Does anyone make concentrated insulin infusions? What is the Upper Hard Limit on your smart pump?

Has any institution eliminated return bins from your ADC machines (we use Pyxis) and had all unused medications either tubed down to pharmacy or discarded as pharmaceutical waste? All controlled substances would be wasted with a witness; controlled substance waste would be tracked through diversion monitoring with Bluesight.

Looking to hear your experiences, what drove this decision, and how you feel about it since. Would you make the same decision again? Pros/cons.

TIA

obesity dosing with heparin infusion has required creative strategies such as hanging two 50 unit/ml premixed bags with total rate above 4000unit/hr (hard max in alaris). does anyone have experience with challenging high doses to reach therapeutic goal? do you alter the guardrails to allow nursing to turn up rate from one bag? or use two bags? thanks in advance
jbrady@svmh.com

TJC recommends pharmacy address anticoagulation in perioperative setting, can anyone share their approach or protocol? thanks in advance
jbrady@svmh.com

Good afternoon,

Good afternoon,

Could you please share your practice for medication order verification in the general ED? Specifically, do you rely on auto-verification of orders, and is the process different for pediatric patients (i.e. pharmacist review is required for pediatric patients)?

For those of you that require dilution of promethazine, especially for those that dilute it in 50mL NS.

Who does the dilution? Pharmacy? Nursing?

We talked about pharmacy diluting the product in a 50mL bag, but with the short BUD and potential influx of 30-50 orders/day, I don't think it's within our logistical reach.

For those of you that require dilution of promethazine, especially for those that dilute it in 50mL NS.

Who does the dilution? Pharmacy? Nursing?

We talked about pharmacy diluting the product in a 50mL bag, but with the short BUD and potential influx of 30-50 orders/day, I don't think it's within our logistical reach.

Does anyone have an Assessment of Risk form template they really like? I have a form specific to Hazardous Medications, but I am looking for something more general that can be used for almost any situation.

Thanks!