Hello All,

Based on ISMP best practice, patient weights should be documented in admission and during each appropriate outpatient or emergency encounter.

*Appropriate = encounter where patient being seen by licensed independent practitioner (excluding emergencies where delay may cause harm). Encounters that involved lab and other services where medications are not prescribed or administered would be considered an exclusion.

We have had 3 cases of cardiac arrest after a dose of ceftriaxone via IV push, one case in 2020, and two more cases recently. None of these cases had any other features of typical anaphylactic reactions (no hives, swelling, etc.).

Have any other sites experienced similar cases? If so, what were the details of the events? Do you believe the rate of IV push increases the risk of these reactions?

Any information would be much appreciated!

With the unavailability of Lorazepam 2mg/ml injectable solution, has anyone been diluting the 4mg/ml concentration to 2mg/ml? The stability data on this is not concise.

Does anyone have electronic or other tools in place to help prevent ADRs associated with morphine use in patients with severe renal dysfunction? I'm thinking maybe focused alerts for ER formulations, opioid-native patients, high doses, and/or patients who are receiving frequent prn doses?  There's no specific manufacturer recommendations, but Lexicomp provides some general guidance on dosing, etc.  

Thanks!

Our organization has moved to a new vendor and there are some opportunities for us to "fill the gap" based on what is available.

Specifically in the anticoagulation area.

Thanks

Hello-
We are working to implement a policy/procedure to outline the management of dual pharmacist order verification for select medications. We would greatly appreciate learning from others if anyone is willing to share their policy or processes. We are interested in your criteria for how a medication is determined to be added to the dual pharmacist order verification list, etc. Thank you!

Jennifer Noped

Since transitioning to outsourcing TPN, we are likely to have increased home TPN usage in the hospital for the first day of admission. Does your facility have nurses document home TPN administration on the MAR like a regular home medication? If so, how is it built out-- as a general "home TPN" order or as a specific TPN order broken down into components? Thanks! -Melody Sun, CHOC Children's

We use EPIC and are looking to create an order set for alteplase and heparin used during EKOS procedures to treat pulmonary embolism. If anyone has an order set already built (Epic or non) please share. Thank you for your time!

Shari Waldron
Providence St. Mary Medical Center
401 W. Poplar Street
Walla Walla, WA 99362
(509)897- 2055

Hi there,

Per Package Insert (25% vial)-

"Crystals may form in Mannitol Injection, especially if the solution is exposed to low temperatures. If crystallization occurs, warm the vial in water at 80°C and periodically shake vigorously to dissolve the crystals."

While the above recommends water for rewarming, other resources such as ASHP Injectable Drug Information book suggests, "The use of a water bath is not recommended."

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