Are you converting to the ENFit enteral feeding and medication products? What is your timeline for conversion? If you have converted, any tips on a smooth transition?

Thank you,
Ann

Ann Jankiewicz, PharmD, BCPS, FASHP
Medication Safety Officer
Rush University Medical Center
Chicago, IL

Focusing on severe sepsis and septic shock as defined by CMS, we are interested in administering broad-spectrum antibiotic coverage (which typically will require at least two different antibiotics) as rapidly as possible. Often times, antibiotics are Y-site compatible making it feasible to administer two antibiotics simultaneously. However, there is a theoretical concern that a patient could develop an allergic reaction, and if both antibiotics were infusing simultaneously, it would be difficult to determine which antibiotic is responsible for the reaction.

What is your institution’s policy regarding titration orders?

The Joint Commission surveyor has stated that orders must show:
• Starting dose
• Maximum dose
• Dosing increment by which to adjust
• Outcome endpoints used to determine dosage adjustment needs
• Specific time interval for reassessment/adjustment.

Can anyone share their institution’s policy on titration orders, order build specs in your EMR, or have experience with Joint Commission surveyors scoring your titration orders?

Thank you.

Hoping others could share the labels used by nursing to label IV products that they need to admix on the unit (e.g. ampicillin, Unasyn, other short-expiration items). Working to reformat our labels to comply with CMS guidance.

Thanks,

Don McKaig
Pharmacy Specialist, Medication Safety and Quality
dmckaig@lifespan.org

Quick question folks:

I wanted to know if dantrolene use in the setting of NMS (OR dantrolene use in general) at your facility always require the patient to be in the ICU.

Thank you.

Hello all! I have two students (Kristina Rosus and Irene Yang)who are we are P3 student interns at Carilion Roanoke Memorial Hospital in Roanoke, VA. For our summer project we are monitoring enteral medication administration to ensure that patients with feeding tubes are receiving their medications optimally.

Are any of your organizations filtering all pediatric and/or neonatal infusions?

What is the process your hospital uses for delivering IV medications less than 1 mL?

Here's our situation (which I think may be yours too)!
1) Priming volume of tubing is 1 mL
2) When med is, for example, 0.3 mL over 15 minutes, in 15 minutes this med is still in the tubing
3) The flush should run at the same rate as the med which will then take excessive time
4) Some nurses have been running the flush(1mL) over 5 minutes which really means the med is now going over 5 minutes

Solutions we have thought of and problems:

Hi All,

Does anyone have nomogram for dose adjusting argartoban based on aPTT for heparin induced thrombocytopenia and is willing to share?

Thanks in advance.

Agnieszka Pasternak
Akoniecka@northwell.edu
Agpasternak@yahoo.com

The Joint Commission has just visited our institution and asked about the follow best practice recommendation of eliminating 1000 ml sterile water bags outside of the pharmacy. Our Medication Safety Meeting has been addressing this issue as it relates to the Neonatal ICU use of the 1 liter bags with CPAP machines. Would appreciate any advice on how to best approach this issue as I am told there is no alternative. The notes form our Medication Safety meeting are as follows: