Hello safety leaders,

We are seeing cases of heparin infusions not discontinued prior arrival to the OR. We are evaluating the process and ownership issues that have been identified. We are an Epic institution, and pharmacists manage titratable heparin drips. Physician education has focused on how to hold/unhold heparin in Epic.

Would anyone be willing to share their protocol for using phenobarbital in alcohol withdrawal patients? Some of our doctors prefer it over lorazepam and we want to make sure we are monitoring for patient safety. They're ordering 130mg IV q1hr prn at the beginning and then transitioning to oral doses. There is some disagreement on the max dose (15mg/kg/day IBW vs 20-30mg/kg IBW per hospital stay). I'd love to see what some other facilities are doing. Thank you!!

What does your facility use for NeoNatal Starter TPNs? Do you use a pre-made product or does the pharmacy prepare the starter solution?
If pharmacy prepares the solution, what is the formula/recipe used and what is the reference used to confirm stability of the recipe?

We are looking for stability data for our formula and our facility does not allow for extrapolation. If anyone knows of literature that supports extrapolation of concentrations, please share.

Many thanks!

Our institution is currently assessing our workflow surrounding standard practice for ordering and obtaining concentrated calcium chloride for emergency use while maintaining safety measures to prevent inappropriate administration via peripheral IV route that may lead to extravasation. Currently, concentrated calcium chloride is not available for physician ordering but is available for pharmacists to order, however a recent incident led us to realize we don't have a clear protocol for how this agent should be obtained.

We are in the process of updating our high alert medication list and are considering setting criteria for meds to add/remove/modify, etc.

Aside from ISMP's community and acute high alert medication recommended lists, are you assessing other external or internal information? Has your organization set any criteria or thresholds for addition or removals?
For example, if there was a medication error that occurred, does that meet criteria to be added? Or if there are zero reported medication errors/close calls, do you remove? Any additional thoughts?

Hello! We are reviewing our configuration setting for the Key Click Audio setting in the BD Alaris infusion pumps. The default is to have this setting enabled so there's a beep with every key pressed. We've had a request to disable this setting so was wondering if others have turned that off or have reasons to leave it on. Thanks for sharing your thoughts!

Good morning - For those of you who have pharmacy technicians as part of your medication safety team, would you be willing to share a job description or a message on the qualifications and some of the main job duties.

Thank you!
Luanne Sojka, PharmD, BCPS
sojka.luanne@marshfieldclinic.org

Our facility is considering placing un-activated mini-bags in Pyxis. We would attach the antibiotic vials to the bags in our IV room. From what we have found, we could use a 30 day BUD on the 100 mL un-activated bags in Pyxis. Nursing staff would activate the bag immediately before administering. For those that use a similar setup - did you have issues with bags being hung without them being activated? (essentially a missed dose of antibiotic?) The concern for doses not being activated has been our one road block so far.

Would anyone be willing to share their institutions corrective action plan(s) for failed gloved fingertip sampling and/or media-fill testing? Thank you in advance for your consideration. Amy

Good afternoon!
My health system uses the Epic platform heparin calculator, and we are currently working to enhance the safety of our process with the calculator. If you use the Epic calculator:
1. What safety concerns have you identified?
2. Were you able to resolve concern(s)?
3. If so, how did you resolve the concern?
Thank you!