I'd like to hear what is the structure for conducting medication-related RCAs in your organization.

Who does the RCAs in your hospital?
Risk, or Quality & Patient Safety dept, or
the MedSafety person (Pharmacy)

If the Med Safety person is responsible for the RCAs, what is the level of involvement?
MedSafety helps by investigating medication process component;
or MedSafety facilitates and conducts all aspects of the RCA process?

When/how is Risk involved in the RCAs?

thanks!
Susan

For hospitals that use the Alaris syringe pump module: Do you keep the near end of infusion alarm on? Is it only on for certain libraries? If so, which one?

Our nurses are complaining about it and want it turned off but others feel it is necessary for the life-sustaining continuous infusions.

Thanks,

Randi

We're a pediatric hospital (300+ beds) and have a fairly large amount of orders for IV tylenol. The problem is we have so many orders as both scheduled and prn that we're running into problems balancing waste vs emergent need. How are you handling IV tylenol orders at your institution-both prn and scheduled. Is anyone stocking the large vials in their automated dispensing cabinet? We are now asking RNs to message Rx when prn doses are needed to avoid drawing them up and later discarding them because they've reached their beyond use date-- before they could get used.

Thanks.

This may have been discussed before recently...but does anyone have a different title other than Medication Safety Officer/Medication Safety pharmacist? Assuming you do Med Safety of course...

Anyone else out there coordinate both drug use policy/P&T AND med safety? What's your title?

Thanks!
Jennifer

To clarify, carrier fluids are used for connecting secondary medication infusions that cannot run with maintenance or TPN fluids. For Carrier fluids, I'd like to know if you have protocols, standing orders or policy.

Thank you

In preparing for further work on the ENFit feeding tube connector situation described in our April 9, 2015 issue (http://www.ismp.org/newsletters/acutecare/showarticle.aspx?id=105), I am trying to put together a list of oral liquid medication doses where the volume is 2 mL or less. I am mainly interested in doses used for neonates but also would appreciate doses for infants and children and even adults. We would really appreciate it if you or your pharmacy technicians could help us with a list.

We have had some recent errors with non-formulary medications. Wondered what others are doing with these meds. Has anyone considered adding them the their "high risk medication list" or have any creative ideas for managing them.

Does anyone currently use an oral dosing cup with only mL markings?
If so, please let us know the manufacturer.
Thanks
Sue

I just finished attending the USP 800 presentation at the ASHP Summer mtg. It was a great review of chemo handling, but I wanted to hear more about handling non-antineoplastic hazardous drugs. Guidelines for handling chemo are pretty straightforward and staff are on board. It's the non-chemo (spironolactone, carbamazepine, oxytocin) that is causing confusion and frustration. The speakers said to do an "Assessment of Risk", then you can handle non-chemo differently...I am not a toxicologist and do not feel that I have the expertise (or liability insurance!) to make that kind of call.

Hello,

Our maternal-fetal medicine group occasionally does intrauterine procedures including PUBS and intrauterine fetal transfusion. To facilitate cannulating the umbilical cord (obviously a high risk procedure) they require vecuronium to paralyze the fetus. We are trying to standardize how we dispense vecuronium for these procedures since these cases are so high risk and cause so much anxiety for both the pharmacists and physicians.

Do any other institutions perform these procedures? If so would you be willing to share your dispense process?