With the recent addition of med reconciliation in the ISMP targeted best practices for hospitals specifically the recommendation of "Obtain most accurate medication list possible upon admission to organization before first dose of medication is administered"...

We have been converting to outsourced controlled substance products (ie, morphine 30mg/30mL), but we are concerned about the risk for diversion when the syringes are actually 32mL or 33mL because the outsourcing pharmacy includes about 10% overfill in some lots. We store these syringes in Pyxis so the nurses can remove them easily. How does your site handle this? Do you have a process to track these overfill volumes? Thanks in advance! -Melody Sun, CHOC Children's

Hello MSOS community.

PROBLEM:
- We are challenged with our outpatient pharmacy system which can not print reduced size symbols for half like 1/2.
- We do not use 1/2 as that could be mis-read as "one or two"
- We have seen a risk with members mis-interpreting "Take one-half tablet...." as 1.5.
- We have reached out to vendors (First Data Bank's Meducation, and ISMP) as well to see what can be done in our system.

Hi there - we recently had a patient with history of HIT who had a procedure that essentially required heparin, and our hematology team was not consulted in a reasonable time.

Does anyone have a process to encourage surgeons to proactively consult hematology in situations like this? We are an Epic institution.

Greetings!
We would like to transition to majority nebulizers (duoneb, albuterol, atrovent) instead of combivent/ atrovent/ albuterol inhalers but for the ventilated patients we have issues with the expiratory flow sensor and expiratory filter becoming clogged and the filter has to be changed while still in use. We use the GE Carescape with a valve ventilator exhalation flow transducer for the exhalation filter.
Do other facilities use nebulizers on vent patients and have you had issues with clogging? Thank you!

I am curious how other sites are interpreting this or have found other guidance. We use the Aerogen syringes for some of our continuous inhalation products and they currently are not manufactured as sterile and we have not identified a sterile, safe substitute.

1.1
Scope
1.1.1 CSPs affected:
• Aqueous preparations for pulmonary inhalation.

We are an Epic facility and we have had a couple close calls with incorrect medication dosing due to adjusted body weight not being calculated if the gender identity fields do not indicate male or female. If responses such as "chose not to disclose," "Unable to collect," or "other" are chosen in any of the gender identity fields then Epic logic can't complete calculations requiring a male or female designation. Wondering if other facilities have experienced this and what was done help close this gap? Thanks!

Hi,

We were recently asked by a provider to add magnesium 5g/10mL vials to our crash carts and Pyxis cabinets in OB areas for preeclampsia patients who do not have IV access. The dose for preeclampsia IM is 10 grams.

Historically we have stocked the smaller vials 1g/2mL which can be used for IM injection if needed. We are hesitant to stock the larger concentrated vials in a crash cart or Pyxis. Will you please let me know what you stock for preeclampsia and where you store this?

Thank you,

We have had a couple of recent near misses related to medications being discontinued from the home medication list by med rec technicians that should not have. Because we utilize CancelRx, the discontinuation of the medication triggered a message to the patient's pharmacy to cancel the prescription. Has anyone else experienced issues with this? Are there any workflow changes anyone has implemented to help prevent this from happening?

Hello,

How fast do you allow magnesium to run in your facility? We have some providers (e.g., emergency) who want to give 2-4 grams over 20 minutes specifically for a fib, but nursing is concerned and at times has refused to give. Obviously we give higher doses for preeclampsia. I have found a couple of references that show safety when exceeding the 150 mg/minute recommended max rate, but I am curious what other facilities allow.

Thank you!