Hi all,

We currently have an Adult DKA and HSS protocol, IV insulin algorithm, and OB IV insulin algorithm. We have been seeing an uptick of euglycemic DKA within our institution primarily due to the increased use of SGLT2i and in our OB/LDR population. It is causing confusion amongst our provider and nursing staff as our current guidance does not appropriately address euglycemic DKA. This has ultimately led to errors which we are wanting to prevent in the future with appropriate guidance.

1. Do you have an euglycemic DKA protocol/guideline that you are willing to share?

Hello,

We are looking to update our process on Methrotrexate administration for ectopic pregnancy. Would anyone be willing to share their practice or policy? Our pharmacy is not a 24 hour pharmacy, which somewhat complicates the process.

Thanks,
Courtney

Hello everybody

Our pharmacy wants to provide potassium chloride solutions in ready-to-use infusion bags. They proposed a concentraton of KCl 20 mmol/500 ml (= 0.04 mmol/ml).
But we received feedback that with this concentration patients will receive too much fluids.
What kind of ready-to-use KCl are you using?

Many thanks
Kristina

I've seen a variation of this question posted before, but not answered.
How does your organization set the nurse up for cyclosporine administration via enteral tube? The manufacturer supplied syringe is NOT ENFit compatible, creating a difficult situation for administration of this hazardous drug.

Appreciate input from others,
Stacie Ethington MSN, RN-BC
Medication Safety Nurse Specialist
Nebraska Medicine

I am looking to see if there is an easy way to monitor for "Cancel Remove" transactions in Pyxis ES. About 10 years ago I remember at a former facility I worked at we were able to catch a nurse using this function to open a drawer to a premixed bag of PCA medication and removing 1-2 ml's at a time to divert the medication. Was wondering how others are monitoring for this to prevent diversion of types of products that could be tampered with and possibly go unnoticed?

Thank you for any help with this!

Is anyone using IV opioids via nebulized route for comfort care patients? Is pharmacy or nursing diluting prior to administration? Any precautions for nursing or RT when administering? What concentrations are used? And if you use Epic, how is it ordered? Thank you.

Our organization is changing oral contraceptives dispensing from inpatient pharmacy to consistently remove placebo tablets from the pack (before dispensing the entire pack as a bulk item for nurse administration).

If your organization removes placebo tablets from oral contraceptives in pharmacy:
1) How do you communicate that placebo tables are removed to the ordering provider?
2) How does the ordering provider designate hormone withdrawal (if this is desired vs. continuous hormone administration)?

Hey everyone,

Do you guys have creative ways to address allergic reactions to medications that may help prevent/or bring awareness to possible allergies to contrast? I ask because we recently had a patient with an allergy to Bactrim already listed on their chart who experienced an allergic reaction to an ultrasound enhancing agent (sulfur hexafluoride lipid-type A microspheres) for an Echocardiogram, and required treatment and ICU monitoring for a day.

Looking forward to hearing back.

Jameika Stuckey, PharmD
University of Mississippi

It has recently come to our attention that Trissel's designates Ketamine and LR as incompatible at Y-site. Our anesthesia group disputes this assertion, saying the study it is based on is flawed and ORs everywhere have been using Ketamine+LR for decades with no issues. Our nurses rely exclusively on Trissel's/Lexi to determine compatibility, so this has caused some concern.

Have any of your institutions discussed this incompatibility with anesthesia or ORs? Do you have any scenarios where you use blanket exceptions to compatibility designations in Trissels?

With increasing risk of cybersecurity attacks, wanted to see if organizations have good examples to share of downtime RX profiles they have created help optimize ability to maintain accurate, complete pharmacy profiles.