Good Evening,

We are in the process of evaluating our restraint freedom policies/program and I would be interested in what strategies other health systems have implemented.

Would anyone be willing to share any tools, assessments, order sets, etc. they have in place?

What role do medications play? Specifically antipsychotics, antidepressants, anxiolytics?

Any special considerations for mechanically ventilated patients? Brain injury?

Thank you.

We are an EPIC system with Alaris pumps and went live with EHR-pump integration approximately 18 months ago. It came up recently that we actually have 2 active barcodes on our internally compounded IVs - the QR code on the patient label and the manufacturer barcode from the fluid bag. The concern is that if the RN scans the manufacturer barcode, the system might recognize it and run it as a fluid (and therefore at the wrong rate) if the patient has an order for that agent, despite the fact that drug has been added to the bag.

Good morning!
Does anyone have a preceptor manual/guide to share including expectations for precepting resident longitudinal CQI projects?

Thanks for sharing!

I am trying to find Joint Commission, regulations or best practice workflows when it comes to medication errors. Are nurses supposed to amend the chart and document the error on the MAR? Do they leave the MAR as is and make a note. If anyone cam provide links I'd greatly appreciate it.

Has any institution moved away from rounding heparin to the nearest 50/100 units? Considering this as part of the solution to heparin-related errors, but have not found any information on it one way or the other yet.

I know this topic had been discussed a few years back, but I wanted to repost in case anyone has any new experience/knowledge on the topic. Has anyone operationalized an opioid assessment for tolerance, and if so, who does the responsibility lie with - the physician, the nursing staff, or the pharmacy? Is that assessment used for prescribing? Also, if anyone would be willing to share what their assessment looks like in the EMR it would be appreciated!

Thanks,
Michelle Heidel

Hello,

What does your organization use as a required time for administration, waste, or return of controlled substances?

Do you have exception to policy for procedural use?

Would you mind sharing your policy?

If you don't require a time, do you have an alternate strategy to mitigate risk of diversion?

Thank you!

Jeff Schnoor, Pharm.D.
Medication Safety Coordinator
UVM Medical Center

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?