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.

With our next Epic upgrade our providers will now have the ability to put medication orders on hold, something they have not had before. In reviewing the recommendations from the most recent ISMP Quarterly Action Agenda we would like our pharmacists to be involved in reviewing held orders daily, especially high alert medications, and are starting to work on what that process would look like. Are there any Epic facilities that have a process or standard work for pharmacists reviewing held orders that they could share?

This has been resolved thank you!

Hi, I understand that error reporting is not punitive. However, when a pattern is identified with an individual, how do you handle team members? Do you follow an escalation process?

Our institution is considering moving to Myxredlin insulin bags from Baxter, but it was recently discovered that the product contains a phosphate buffer. Lexi-comp shows compatibility w/ calcium at the y-site, but when checking with Baxter to confirm, it sounds like they haven't conducted any studies on compatibility of Myxredlin with IV solutions - so no data to support. Wondering if any other institutions that use this product were aware, and if so, how have you handled this. Thanks for your consideration!

We recently transition from auto-verification to pharmacist verification in our periop areas. We are now having some issues with prn pain duplications. (i.e. pt was on oxycodone prn for severe pain while on the floor and then once in pacu, an order for dilaudid prn severe pain is ordered). Since these are 2 different phases of care, would having both of these ordered be allowed by TJC? If not, does anyone have any suggestions on how to navigate this scenario? Thanks in advance!

Good day all,

Curious if anyone is allowing duloxetine capsules to be opened for feeding tube administration, etc?

The generic products (not Drizalma which has been discontinued) appear to have been reformulated to have smaller sprinkles within the capsules that a small enough to pass through a feeding tube. In addition, there appears to be a study supporting stability and this practice. https://www.sciencedirect.com/science/article/abs/pii/S0149291808800549?...

When scanning the square 2D Matrix barcode on vaccines, we have found the lot number field in EPIC is populated with the lot number...plus a long string of extra digits. If those extra digits are not manually removed, it creates inventory discrepancies with our state-supplied vaccines (which look for an exact match for lot number).

For background: We are scanning the outer box 2D matrix barcode, and documenting administration using the EPIC immunization activity.

Our ICU has started using cycled dexmedetomidine drips to promote a more normal sleep/wake cycle to prevent/treat ICU psychosis. The providers want to include naps as part of the workflows in our patients 2 years of age and younger. We are exploring order options within Epic to prompt the RN to change the doses and allow for usual barcode scanning. Does anyone have a process that works well at your organization?