How are orders built to provide a time for preop antibiotics? We use Epic and have a frequency of ON CALL or PREOP. The order still populates the MAR with a start time so we are seeing an increase in antibiotics being given early. I would love to hear how others have addressed this.

Hi everyone,
We are trying to be more proactive in catching overrides that don't have orders/aren't documented/aren't wasted, especially with agency staff who might not come back for days.
Years ago I worked with AcuDose and it was very easy to run an override report on demand, or schedule it to be printed on the unit. The charge RN would run the report at shift change and anyone who had an override had to sign off that it was complete before they left for the day. We are struggling to find a similar workflow for Pyxis.

In efforts to help bring attention to scheduled CHG (chlorhexidine gluconate) wipe baths, our CLABSI taskforce is requesting it would be helpful if these orders populated the MAR.

Do any other hospitals populate CHG to the MAR? If you have experience with CHG on the MAR any input would be appreciated (barcoding, bypass pharmacy verification, etc.)

Thanks,
Jenn

Please share if you have a policy clarifying medications administered via a feeding tube (specifically jejunostomy tube).

Hi,

Our health system uses EPIC, and we have a nurse-driven vaccine protocol for inpatients who qualify for a pneumococcal vaccine or flu vaccine. Our current process is that the order generates an entry on the medication administration record in the PRN field. The entry says to give the vaccines "prior to discharge". We've found that most patients don't end up getting vaccinated.

Do any of you have a successful strategy that you can share? We'd love to learn from you.

Thank you,

Dan

We are revisiting the issue of insulin pens vs. vials and would be interested in knowing what safety measures other institutions have put in place to ensure the safe use of vials?

Our organization has been reviewing the utilization of Sugammadex and would like to explore what other institutions are limiting their use of sugammadex (protocols, usage criteria, etc.)?

Is anyone compounding 10unit/ml insulin bags to give high dose insulin for CCB or BB overdose (alongside dextrose/K infusions)? I'm worried about the 10 fold difference and also how to provide this after-hours at a small community hospital.

How does your facility document RN boluses doses off a continuous infusion or PCA pump? We use Cerner and currently have the PRN or additional RN boluses ordered separately, which is often a different concentration. As a result, our nurses are unable to confirm and chart the correct volume delivered, and this also leads to inaccurate I/Os documented. Thanks in advance!

-Melody Sun, CHOC Children's

Hello colleagues,

My system is acquiring Pyxis machines for our diagnostic imaging departments, and we are discussing whether or not these ADMs should be profiled.  We are being told that most sites to not profile their radiology machines.  Based on 1) what we plan to stock and 2) low BCMA rates for the department, I am inclined to advocate for profiling.  Contrast agents currently autoverify unless there is an allergy.

Interested in anyone's experience.  If you are profiled, what challenges have you faced?