How do you manage sickle cell patients on long acting opioids when a provider wants to start PCA? We have a provider advocating that the patients stay on their long acting opioid and add PCA without a basal rate to use for breakthrough pain. She feels this is safer than stopping home opioids and trying to convert to IV with a basal rate.

Our current policy says no additional opioids with PCA so she wants an exception made for these patients.

Thank you!

Carol

I am looking to increase compliance in tracing the line (bag -> pump -> patient). So far we have placed small laminated cards to the pump, and daily huddles. It's not working. The system we use is Meditech and pretty much frozen from build as we are switching to a new EMR. I have a RCA coming up and would like to learn different opportunities you do to ensure nurses trace the line. Any insight greatly appreciated.

I'm at an EPIC based hospital, and have encountered a couple of safety events relating to patients admitted with an implanted intrathecal pain pump that is managed in the outpatient setting.

- Do you have a policy for implanted pumps (can you share)?
- How does your facility document the implanted pump? Are drug specific orders placed and is it charted upon in the MAR?
- What's your process to adjust the infusion rate or turn off the pump if an adverse drug event occurs?
- What requirements do you have for notifying the outpatient prescriber of the pain pump?

We have seen a number of reports from Nursing staff regarding repeated occlusion alarms when running Ketamine infusion via the Alaris Syringe-pump module using a 30 mL syringe. The concentration is 5 mg/mL. Our theory is this may be due to the concentration of the medication.

If applicable, how are ketamine infusions administered at your institution? What concentration are you using? Have you seem a similar issue with occlusion alarms? Thank you!

I am gearing up for my 3rd medication safety student and am overall very excited about the opportunity to share my passion for medication safety with the next generation of pharmacists. For anyone who also has established an elective medication safety APPE rotation, would you be willing to share your "course objectives" or syllabus for your rotation? As a small rural hospital pharmacy director, I am by no means a "Medication Safety Officer" but feel that our setting is still very conducive to learning about medication safety. Are there any articles, books, videos, etc.

Do any sites have a nasal decolonization protocol? Even without a formal protocol, what products are you using?

I am currently evaluating between providone-iodine and alcohol based products, but of course, there are no head-to-head studies. Seems like either would be fine, but would be interested if someone has info showing superiority or why you went with a particular product.

TIA!

We're revisiting ISMP's recommendations on topical thrombin. What precautions has your facility put in place to prevent IV administration? Does your pharmacy prepare doses?

https://www.ismp.org/sites/default/files/attachments/2018-03/20170112.pdf

Thanks!
Joanie

1. For surgical prophylaxis in the OR, are your providers administering cefazolin IV push or intermittent infusion?

2. If intermittent infusion, what is the typical infusion duration at your site for anesthesia's purposes?

3. We are avoiding IVP due to some cases of serious ADR's but considering logistical concerns with a 30 min infusion which is our standard build outside of the OR setting.

4. If you made a switch from IVP to intermittent infusion, what was the rationale for that change at your site?

Is there a best practice recommendation for scanning individual ingredients vs. the final product when there is nurse admixture at the bedside?

An example: nurse has to mix an IV antibiotic prior to administration. When performing the scan, is your system process to have each ingredient scanned, or is a final product label/barcode provided to scan?

My gut feeling is that best practice would be to scan individual ingredients. There is always the possibility of a wrong product selection prior to the final admixture.

I know this has been discussed but i can't find the thread. Currently we do our DC for correction scale insulin at the pyxis machine. One of our COVID units is utilizing a clean nurse to hand the medications across the barrier to a COVID nurse. This process seems to be working but we are unable to accomplish the double check at the Pyxis machine. Has anyone tackled this problem already?
Appreciate any help you can officer.
Kim Gaillard