How early does your institution pull expiring meds out of inventory? Trying to find the sweet spot between excessive drug waste and ensuring enough time in the daily workflow to remove/replace meds before they outdate.

Does anyone have a specific Nursing policy on the time frame they have to respond to a low electrolyte lab (K, Phos, Mg)?

One of the issues we have with our electrolyte (K,Mg,Phos) protocol orders is that the RNs do not act on the lab value in a timely manner. The question has come up, what exactly is a time window in which they can still act on an "old" lab value? Do you have a policy defining when the level is too "old" to act upon, do you recommend rechecking the level or getting a Physician order to proceed per the protocol despite the "age" of the level?

Does anyone have experience using the higher concentration of 5 units/ml IV bag for managing patients with CCB or BB overdose? What processes have you put in place to prevent errors with administration via the pump?
Do you have facilities that do not have 24 hour pharmacy coverage and do you allow nursing to mix this when pharmacy is closed?
Do you allow this therapy to be initiated at stand alone EDs?

Does anyone have experience using the higher concentration of 5 units/ml IV bag for managing patients with CCB or BB overdose? What processes have you put in place to prevent errors with administration via the pump?
Do you have facilities that do not have 24 hour pharmacy coverage and do you allow nursing to mix this when pharmacy is closed?
Do you allow this therapy to be initiated at stand alone EDs?

There is lots of discussion in our Health System related to a change from Normal Saline to Lactated Ringers as the most commonly used base fluid due to literature that shows balanced fluids are superior to crystalloid ones in some outcomes.
Have other hospitals made this change and found a good process for education / tool for nurses around the incompatibilities of LR with certain medications.

Thanks

For those that listened to our Member Briefing webinar today and would like to hear more about independent double checks for subcutaneous insulin, you might want to listen to a previous brief given by Greg Burger in December of 2017:

https://register.gotowebinar.com/register/5787674558169084418

(click "register" and it will bring you to the recording)

Hello,

I am looking for tips on how other sites are implementing or are practicing the demonstrated competency for personnel training in USP 800.

Who at your site is responsible for developing or managing the demonstrated competency for each department?

Hello,

Have any hospitals removed combination opioid-acetaminophen products from formulary and have any pearls for how to minimize risk in transitions of care? Our P&T committee is broadly supportive that these products increase risk of cumulative acetaminophen toxicity and don't allow for optimal pain management and it is relatively straightforward to use alternatives for new starts inpatient. The major barrier/pushback is with patients taking these products at home and minimizing medication reconciliation errors on admission and discharge.

Interested to learn what EHR programming settings you have in place for re-timing medication orders?

Is this a task exclusively managed by a pharmacist or do you allow nurses the ability to retime? If nurses can re-time, are there limits on how many subsequent administration times can be adjusted (e.g., 1 at a time vs. duration of order), time duration from original due time the re-timing can be, etc.?

Good morning,

I was at a hospital last week that uses the Yale protocol for non-DKA insulin infusions and the protocol is so complicated that titration adjustment errors occur, even when two nurses are double-checking every aspect of each dosage adjustment.

If anyone is using a relatively simple but effective insulin protocol can you please post?

Thanks,

Dan