Hello colleagues,

The ASPEN recommendation for maximum peripheral parenteral nutrition osmolarity (900 mOsm/L) is rated "weak." Literature supports a higher osmolarity (1200 mOsm/L) for neonates.

Do you allow for a higher osmolarity PPN in adults? If so, how do you justify it from a safety/risk for patient harm perspective?

Thank you,
Megan Fragale, PharmD, MS, BCPS
Medication Safety Officer
Skagit Regional Health

Good morning.

We recently started using EKOS for pharmaco-mechanical thrombolysis. The cardiologist indicated that a typical dose would be 6 mg/50 ml over 6 hours but he may want more over a longer period of time depending on the situation. In our EHR, we built 2 options: 6 mg/50 ml and 12 mg/100 ml and a typical rate would be 1 mg/hr per catheter. For those pharmacies compounding alteplase (using Cathflo), what BUD are you assigning the compound? The package labeling for Cathflo says this:

Does anyone have better directions when Hyaluronidase is administered via the IV catheter?
Lexicomp states "Intradermal or SUBQ: Inject a total of 1 mL (15 units/mL) as 5 separate 0.2 mL injections (using a tuberculin syringe) around the site of extravasation; if IV catheter remains in place, administer IV through the infiltrated catheter; may repeat in 30 to 60 minutes if no resolution (Ref)."

Does the above mean to administer the 1ml volume that would have been administered intradermal, via the IV catheter?

Does anyone have an ADR event reporting policy they would be willing to share?

Thanks,
Jaime

Looking to see how inpatient U500 is being handled in the recent years. A quick search of the forum showed that previously many sites were switching to the U100 option while others are dispensing individual doses in pharmacy-drawn syringes. Is anyone using the U500 prefilled pens? If so, where are they stored in the medical center (ADC vs. med carts) and how are they monitored (if any). Thanks!

Due to national backorder of Lorazepam 2mg/ml vials, we were considering drawing up Lorazepam injection into BD 1ml syringes for IV administration. Does anyone have any info on stability when transferred from Multidose 30ml vial into 1ml labeled syringes by Pharmacy in the isolators?

Our standard for KCl replacement via peripheral lines is to give 10 mEq/100 mL at a rate of 100 mL/hr x however many bags are needed. Our RNs have expressed concern that many of our patients can't tolerate this rate, resulting in issues with charting and accessing the meds in the ADC. This has caused workarounds, delays, and the full run of replacements not being completed.

A group of RNs has requested that we change the default rate to allow for longer infusion times.

Has anyone moved away from the Q1H KCl replacement timeline, or experienced anything similar?

Hello colleagues,

The simple question I have is: are you stocking epinephrine for anaphylaxis in code carts (in any form: amps/vials, pens, kits)?

Background: Med error with verbal order for epinephrine IV for anaphylaxis. We stock anaphylaxis kits in Pyxis, not in the code carts. Nurses think that if we had the kit in the code cart, the error may have been prevented (thinking the kit would have prompted the RN to question the route further).

Do you have your Pyxis/Omnicell/ADC set up to allow user-to-user transfer of controlled substances by anesthesia providers in the OR? E.g. CRNA John pulls fentanyl 100 mcg for an OR case, does not give any to the patient and then goes to lunch. He signs out the med to CRNA Sally in Pyxis.

Thanks,
Will Vincent
Boston Medical Center

Hi everyone - does anyone dilute IVP lorazepam prior to administration? There is a manufacturer recommendation to dilute prior to intravenous administration but I have not seen it done in clinical practice because the volumes are so low (0.5 mL to 1 mL).