Like many institutions we have moved to ideal and adjusted-body weight for our IVIG dosing. However, we are running into a new issue with the weight nurses should program into the infusion pump (we use Alaris) to calculate the infusion rate.

Good Afternoon,

  I am wondering if anyone is willing to share how you store/dispense epinephrine used topically for circumcisions? If you dispense a vial or amp how do you clearly identify that the product is to be used topically to avoid an accidental injection?

thank you,

Heather

We have been discussing some errors and we have had a discussion on what entails "life-sustaining measures." Some of these are obvious (CPR, intubation, surgical procedure, defibrillation and are clearly defined by NCC MERP Index) however, we are struggling with the not so obvious. How would you classify the following interventions (life saving or not):?

1. CPAP/BiPAP use

2. Vasoactive medication use (i.e. norepinephrine)

Tomorrow's ISMP Mediation Safety Alert! notes an FDA alert for healthcare professionals about Wallcur, LLC, simulated intravenous (IV) products in human or animal patients. This is an update to an earlier alert on 12/30/14. There have been serious adverse events associated with misuse of Wallcur demonstration products. More than 40 patients actually received these solutions IV or locally and developed chills and/or sepsis; 1 patient died. One of the products, Practi-0.9% Sodium Chloride 100 mL, contains distilled water, not sterile saline, so hemolysis also might be an issue.

 I am interested in information regarding the preparation and formulation of fentanyl epidurals.  Currently we are batching our epidurals in the IV room and providing them to our anesthesiologists in a locked refrigerator on the L&D floor.  The formula we use has been in practice for an undetermined amount of time, I do not know that it has ever been evaluated for best practice since I’ve been at the institution.  The bags contain fentanyl, bupivacaine, and epinephrine.  We want to make the compounding of this bag simpler, and thereby safer, by removing the epinephrine.  Do you have any

Our Medication Safety Council conducted a medication dilution survey for our inpatiet nurses similar to the survey in last summer's ISMP Alert.  After we received the results, which reflected the results found by ISMP, we determined that education needed to be provided.  Unfortunately, we aren't sure where to go from here.  Literature searches turned up very little in the way of evidence based practice for medication dilution and many of the package inserts were vague (e.g., may be diluted, dilute in 5-10mL NS or sterile water.....).  We are looking for any recommendations from others that

Our facility is reviewing the use of allergy bracelets.  Is anyone aware of best practice recommendations round the use of allergy bracelets?  Any input would be greatly appreciated.

Thanks in advance!

Amanda

Looking for policies/examples of how excipient and preservative allergies are handled? For those ingredients that electronic systems do not scan for, or alert against, what procedures are in place?

We are currently working on a policy for administration of intranasal midazolam and fentanyl for patients in ED, out patient suregery, and pediatrics without an IV site.  Doses anyone have any policies or experience with this route of administration they would like to share?

Thanks,

Melinda

Hello Everyone,