Hello!
My organization has been developing a downtime plan for providing parenteral nutrition (TPN, PN) during an electronic health record (EHR) unplanned downtime event. Currently, PN is provided using custom internally compounded PN (using Baxter Exactamix) and using commercially available premixed solutions (e.g., Clinimix, PeriOlimel, Olimel, SmofKabiven, SmofKabiven Peripheral).

Have any facilities experienced precipitation with pantoprazole for injection after reconstituting per the package insert? If yes, can you share the NDC(s) this occurred with, how frequently, and if this led you to change your preferred formulation?

Looking for information on storage of patient own controlled substance that are not to be used as inpatient but no one is available to take them home. Also looking for a process for the same but for non controlled. What are other facilities doing to track, store and maintain these meds until the patient is discharged and they can be returned?

How do you support HIPAA compliance with patient information on medication baggies used to dispense patient-specific medication orders (inpatient encounters)?

- black pens to cover information
- dispense in pharmaceutical waste bins
- peel off label prior to disposing in regular waste
- HIPAA cover labels on the patient information prior to disposing regular trash
- other processes?

Health care providers (HCP) are requesting to dispense silver nitrate sticks for outpatient use for Pedi patients. Per request, HCPs will be assessing parents/guardian's competence before the dispense.

Does anyone have a policy or a procedure supporting this practice and willing to share? I have not been able to locate any safe best practice recommendations and have only found one institution that currently allows it.

Thank you.

Roxie-

Good afternoon,
Our organization is looking to implement a high dose titration regimen for oxytocin during ante partum. For other organizations that do this, do you have any safety strategies in place for nursing? Dual check? Other practices? Luckily, we will stick with our standard concentration with this change.
Thank you,
Stacie Ethington MSN, RN
Nebraska Medicine

Hello,
We are looking for the best practice on how to send the IV bags to the floors if the IV bag comes in the overwrap and it requires a patient label. Does your site remove the overwrap and label with patient specific label or do not remove the overwrap and flag the label and RN adds the label to the bag once overwrap is removed?

Good morning,

We are interested in benchmarking pump utilization in perioperative settings, particularly in children's hospitals (adult information is useful and welcomed as well!). We GREATLY appreciate your reply to the below:

As part of our ongoing efforts to refine our Controlled Substances (CS) Handling Policy, we’ve encountered a particular challenge: ensuring accurate tracking and documentation of controlled substances during off-floor procedures or when given to another for future use.

We are updating our High Alert med policy and I'm wondering how other facilities differentiate between high alert meds that require an independent double check and the ones that do not. ISMP's list is extensive and states that the double check is not always optimal. But, I feel like the staff hears "high risk" and assumes double check for the most part... Also, wondering if people are still including warfarin?
I'd love to see some of your updated policies. Thanks so much!