Hi all,
we currently have ketamine on override in Automated Dispensing cabinets in ED only. We have had a request to add to ICU on override.

Wondering if other folks have ketamine on override in ICU and if so,
1- are nurses allowed to administer ketamine, and
2- do you have safeguards around the withdrawal of this med (witness, alerts, etc.?)

Alternatively if you do NOT have ketamine on override if you can share thoughts or how you handled any pushback.

Thanks in advance!
Dana Miller

I can't find a great answer to this.

What techniques do your institutions use when the OR needs to open a vial to spread the powdered contents into a bone cement? Are there any tools to ensure aseptic technique? One of the nurses mentioned hearing about a catheter, but I can't seem to find anything.

Hello,

Has anyone completed the gap analysis tool? I'm curious to know whether your institution required you to obtain IRB approval prior to completing the tool. Thanks,

Jennifer

Hi, all -

How does your organization handle IM injections with volumes that exceed maximum recommended doses? We've seen a few examples recently, such as methotrexate for ectopic pregnancy and ceftriaxone.

Our pharmacists have been separating into multiple syringes and hand-writing "1 of 2" and "2 of 2" on the individual syringes, however, a single barcode scan at med admission would technically "fulfill" the entire order so there's risk of only partial med administration.

How are other facilities labeling Hazardous medications? I have several questions.
1. Are you using a simple statement "chemotherapy - Hazardous Medication, handle with care"
2. Are you putting NIOSH category 1,2,3 with reference for PPE?
3. Are you building these messages at the primary drug level or placing information in comment sections?
4. Is this information face up on the eMAR for nursing?

If you are a Cerner facility, your input is especially welcomed.

Kind regards,

Kelly

For hospitals that utilize Catcus, Stericycle CsRx, or other diversion deterrent waste systems:

Dear Med Safety Officers,

Does your site allow self-administration of medications for which the package insert has language about administration by healthcare provider/professional if the patient or their partner or neighbor is purportedly a healthcare professional?

For example, this has come up for Vivitrol (naltrexone) injection at my site.

Hi all -

If you've been successful in addressing this ISMP TBP, would you be able to tell me what strategies you found effective?

- Weigh each patient as soon as possible on admission and during each appropriate outpatient or emergency department encounter.
- Avoid use of a stated, estimated, or historical weight.
- Measure and document patient weights in metric units only.

Thanks!

Elizabeth

What is current practice in your organization for flow rate of carrier solutions? I cannot find literature to support what best practice is. I am thinking of infusions like PCAs, insulin, inotropes, etc. that are running a low rate and need a carrier. Thanks!

Hi all -

I'm looking for data on how many organizations have a medication safety team vs. one person covering the entire hospital/organization. If you have more than one person, could you let me know the following:

- the name of your organization and size
- city and state of your organization
- how many people are on your team and credentials (i.e. pharmacist vs. nurse vs. whatever else)

Thank you very much! I'm happy to provide the collated information to anyone who's interested.

Thanks,
Elizabeth