Hi MSOS Members,

We had a patient case when apixaban for VTE treatment was started too soon (12 hours after am dose Lovenox). The patient was on Lovenox treatment once a day dosing regimen before transitioning to apixaban. Alert was not fired since Lovenox order was no longer active at the time apixaban order was placed. Our EHR does not have a look back option turn on. I would like to see what your sites put in place to prevent such an error.

Thank you,

Manisa

Hi All, I would like to poll your Ophthalmology inpatient practices

1. Who administers eye drops for consult patients? (e.g. dilation, etc)
A. Nurse
B. Ophthy
C. Both/other (please specify)

2. Where is the eye drop administration documented?
A. MAR
B. Note
C. Other (please specify)

3. How are drops dispensed?
A. Subsequent to patient-specific order (e.g. standard process for IPD meds)
B. Carried by ophthalmology (similar to clinic practice)
C. Other (please specify)

We are looking to update our small volume intermittent administration practices based on ISMP's recommendation. We are curious is any facilities have looked at financial impact to the organization when implementing this practice change and would be willing to share. Thanks!

Hello everyone,

Under what circumstances do you allow compounding/dispensing of potassium chloride 40 mEq/500 mL for routine potassium replacement?

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

Hello everyone,

I'm from a 300 bed, community hospital and am looking to see how other similar sized hospitals store paralytics for emergency use (ADC, physical kits, virtual kits, ect.) and the process of retrieval in code type situations. We currently do not have adequate pharmacy staff to respond to codes and provide medications for RSI 24/7.

Good morning everyone,

I am currently reviewing our process for subcutaneous insulin administration with the aim to improve the med pass workflow for our nurses.

If you can please take a couple of minutes to answer this short 5 question survey, I will be posting the results next week.

https://forms.office.com/Pages/ResponsePage.aspx?id=DQSIkWdsW0yxEjajBLZt...

When antibiotics are ordered to be given after dialysis (e.g. vancomycin), what strategies have organizations implemented to ensure that they are not accidentally given on non-dialysis days? We currently have a clinical note on the order saying to only give on dialysis days and to make as not done on non-dialysis days.

Does anyone have a neuromuscular blocker SOP they would be willing to share? Looking for a SOP specific to pharmacy that outlines from procurement to stocking steps that pharmacy personnel should be taking (including storage, labeling, ADC settings, etc.) Thanks for the help.

In ISMP’s perioperative assessment, it is recommended that “Irrigation solution containers stocked in, and/or dispensed to, perioperative settings are packaged in 2- or 3-liter bags, pour bottles, or other route-specific packaging to differentiate them from IV bags.”

1. Are you aware of any clinical or safety reasons why a 1-liter irrigation bag would be needed and in which a 1-liter irrigation pour bottle or a 2- or 3-liter irrigation bag couldn’t be used instead (or wouldn’t be ideal for use)?

As we continue going down our journey, I wanted to poll this group on what you had set up in terms of a look back for drug-drug interactions and for duplicates?