We currently have an Epi/Cal drip in our formulary (epinephrine 4mg + CaCl 1gm / 250mL D5W). Our maximum rate is 20mL/hr (~5.333mcg/min of epinephrine). Our plain epinephrine drips (various concentrations) have a max rate of 50 mcg/min.

#1: If you currently use EPI/CAL, what evidence/references do you use to support its continued use? -1990's article in Circulation showed that "calcium blunts epinephrine's beta-adrenergic actions in postoperative cardiac surgery patients." We would like to use this article as a foundation for having EPI/CAL removed from formulary.

Hi all,
Our current Cllaborative Drug Therapy Agreement (CDTA) Process does not require a second pharmacist to double check on these orders. The same pharmacist who receives the consult from the provider, doses the medication and verifies the order.
We have had numerous errors related to this process. Since the ordering pharmacist is the prescriber, another pharmacist should verify the order as a double check. I am working on implementing the double check to make the CDTA process to mirror the process for physician order entry.

We have had several medication ADS misfills due to technicians mixing up medications with several formulations:
- Bupropion XL, SR
- Metoprolol XL, ER
- Diltiazem CD, ER, LA
- Depakote
We have medication bins that label specific formulation along with how many times a day (ie. bupropion 100 mg SR 12 hour tablet vs bupropion 150 mg XL 24 hour tablet; see attached pictures below), yet the errors still continue. Unfortunately, we dont have a robust barcode scanning method because the Rx techs are not scanning each individual tablets when filling pyxis.

CoxHealth is reassessing the current default duration (in the EHR) of a vast majority of chronic meds … think Lisinopril, gabapentin etc. We have it set at 42 days but it seems inadequate as we have more and more patients staying longer than that for varied reasons. CMS CoP state that there does have to be a stated duration, and accrediting bodies have stated that it needs to be no longer than 1 year.

Questions:
a.) What is your current default duration?
b.) Are you aware of the reasoning behind that choice?
c.) Type of facilities/health-system?

Hi,
We are looking for a software program to keep up with our medication area inspections and possibly other quality inspections. Right now, everything is on paper. We have looked at Med Keeper, but wanted to see if there are other options.
Thanks,
Lana Bell

We are building out our Alaris drug library to have 6 CCAs: Adult ICU, Med/Surg, Pediatrics, Neonatal, Oncology, Obstetrics.

I have 2 questions:
1. We have a "step down" unit that uses many of the same drugs as the adult ICU, but with lower upper limits. They have requested we create a different CCA for them, so they can maintain their tighter upper limits (e.g., dopamine 10 mcg/kg/min for "step down" vs 30 mcg/kg/min for ICU). Has anyone run into this issue? I don't see any CCAs with that name, so it sounds like others must've solved this without creating a new CCA.

Hello!

For those of you at hospitals that serve pediatric patients, how do you interpret the NPSG.15.01.01 EP 7 which states "For pediatric patients, prefilled syringe products should only be used if specifically designed for children"? We're curious how to address this EP with enoxaparin syringes, because (as the EP also states), there are safety concerns with using the vial.

Thanks,
Courtney Sutton, PharmD, BCPPS

Hello All,

Would you please share how your organization is handling the following:

- Do you have antiemetics or pain medications on your override list?
- What types of overrides are you reviewing?
- Are you conducting override reviews for non-profiled ADCs?

Thank you,
Ashley Warnock

Hi all

We have a Med Safety & Regulatory Senior Clinical Pharmacist position available. If interested please email me at

G.Prouty@RUHealth.org

Greg Prouty, Pharm.D.
Executive Director, Clinical,Ancillary,PharmacyServices
Riverside University Health system
Moreno Valley, California 92555

I am re-evaluating our current process of medication pass auditing. We are currently using a modified version of the CalNOC Medication Accuracy tool, but it is challenging to use when a patient is receiving multiple medications.

What tools are you utilizing for med pass observations and audits?