Hello fellow Med Safety officers.

I am looking to see how other institutions manage duplicate pain medications ordered via different routes, but for the same pain scale to comply with JCAHO's "Med orders are clear & accurate" standard.

For example:
Post-op ortho orders:
Oxy IR 10mg po q4hrs prn severe (7-10) pain
Dilaudid 0.5mg IV q2hrs prn severe (7-10) pain

Hello colleagues,

For those who have nebulized tranexamic acid for hemoptysis, how do you dispense it? Repackage and dispense from pharmacy or allow respiratory therapist to remove a vial from an ADC based on a linked order?

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

Does anyone have any USP 800 practice exceptions surrounding the use of methotrexate in ectopic pregnancy that allows its use for this indication outside of a sterile compounding containment environment? e.g., assessment of risk (AoR) that delineates appropriate storage, handling, disposal that would allow the frontline nursing staff to draw up and administer these onetime intramuscular doses.

Thank you!

Question for retail pharmacy members: We are discussing paperless options to deliver medication guides to the patient. Has anyone in this group switch from printing the FDA medication guide to give to patient to an alternative paperless delivery of the FDA medication guide? Thank you! Lu

Wondering how your facility prepares chemo doses that are dispensed in bags.
1) Do you start with an empty bag and add the diluent and drug to the empty bag?
2) Do you start with a commercially available bag and remove fluid from the bag? Do you remove overfill? Have you had any concerns of doses being prepared inaccurately due to varying amounts of overfill?
3) Does your process vary depending on pediatric vs adult/adult sized patients?

Has anyone been successful with curbing unintentional therapeutic duplications with PRN orders? I know this has been a long-standing issue with TJC. I perused prior discussion on this topic from 2013-2016, and hoping to see if there was something new we could learn from.

All we have had several errors secondary to missing medications and significant delays once replacements are requested. In larger facilities, would you be willing to share process metrics in terms of time required to re-dispense, verify and deliver a medication to the nurse?

Any insight would be helpful.

Thanks,

The anesthesia department at my institution is starting to explore the use of bar code scanning of medications in intra-operative areas (we use EPIC). Are there other institutions that have incorporated this into OR processes, and would you be willing to share your experience implementing this process as well as what the barcoding process actually looks like in the OR suite?

I am trying to create a MUE plan for my institution. What are some of the ways your institution identifies MUEs ?

My thought is to run routine/annual MUEs for high risk / high cost / rescue meds-

- kcentra
- vancomycin
- naloxone
- flumazenil
- dextrose
- heparin
- warfarin

and in addition, identify other high risk high cost meds - 4 per year to perform MUE

Would love some thoughts on how this is done at other institutions.

Thank you.

We did not develop specific formularies for areas such as the IV room, peds, oncology, etc when we implemented Epic many years ago (not sure it was an option) and have one main formulary. We are now identifying a need for a better option to ensure labels print in the correct area and understand there is the capability to develop separate formularies. IS is reluctant to make these due to the large amount of work.