Currently our health system follows ISMP recommendation of having basal insulin dispensed by pharmacy in a patient-specific barcoded syringe. We have recently upgraded our ADCs that will now print patient specific labels. We use these labels for the sliding scale/correctional fast acting insulin in the ADCs (much better process than old way with pharmacy flag labels).

Hi everyone -

Where does your organization require an administration IDC for infusions - new bag, bag changes, rate changes, etc? We are trying to determine best practices and are curious what other organizations are doing. Thank you!

Liz

Hello! We recently received feedback from a surgeon that a change of brand of oxymetazoline, from AFrin to Sinus Extreme by Vicks, has resulted in an undesirable change in effectiveness. In this case, oxymetazoline was being used in infants, as a hemostatic agent where it is applied on pledgets to mucosa surfaces and the ear canal to vasoconstrict small vessels. Has anyone else received feedback on the effectiveness of Vicks brand oxymetazoline versus Afrin brand?

Does anyone require chain of custody documentation for fentanyl patches at the end of each nursing shift? We recently had an event where an RN noticed a patient's patch was missing. It is unknown how long the patch had been off, or where it went. I was thinking about how we require 2 RNs document the volume of continuous infusions of controlled substances that remain at each change of shift. Should there be some type of acknowledgment each shift that the patch is still there?

Hi all,

Has anyone established a goal timeframe for a certain percentage of your smart pump fleet to download current version of drug library after an update (i.e., 90% of pumps updated after 72 hours)? Also, how frequently do you monitor this metric after a library update and what strategies do you use to help reach/maintain this goal?

Thanks!

Sammy Burton, PharmD, FISMP
Medication Safety Pharmacist – Smart Pumps
Cleveland Clinic
burtons4@ccf.org

Hello,

The Baxter Sigma Spectrum infusion pump has a rate accuracy of +/-5%. Over the course of extended infusions (12-24 hours), a +5% variability can cause the infusion to end up to 2 hours early (entire bag is infused, but over less time). This is a concern for abrupt discontinuation of parenteral nutrition.

If you have experienced this phenomenon, with the Sigma or otherwise, I'd be interested to hear how you have mitigated this. We have discussed increasing overfill for all PN orders or patient-specific PN orders.

Has anyone encountered a malfunction in the primary IV tubing with the secondary IVPB backglowing into the primary tubing and solution.

Here's what we know.

- 4 occurence with chemo agents

- The RNs had the primary set up, attached the secondary (primary tubing was in the pump but pump turned off). When the secondary was unclamped the medication from the secondary back flowed (past the back flow check valve) and into the primary solution rather quickly.

The secondary bag was higher than the primary.

Hi - we are an Epic Institution. I have identified issues with our PRN orders where there is no lockout period to prevent PRNs from being given as frequently as the Rn wants up to the max # of doses based on frequency ordered. For example: oxycodone 5mg q4h PRN can be administered at 1305 and 1310 without any warning that this is too close together or shorter than the ordered PRN frequency. The only alert the Rn will get is when they have reached 6 doses of oxycodone and they try to administer a 7th dose in 24h.

If your institution has just a handful of Moderna vaccine administrations a day, do you use the same vial to draw up full dose and booster doses?
Mass vax sites/clinics it makes sense to use separate vials. We have been practicing that on the inpatient side however have been wasting more than half the doses daily, which is a waste of drug, supplies and resources.

Thanks!

Our clinical, regulatory, and legal teams are wrestling with a question that has arisen from some of the complications of COVID. Like many emergency departments, we are holding patients with complex psychiatric needs for placement at other facilities, sometimes for a week or more. Some of these patients also have opioid use disorder and are maintained on methadone. Of note, these patients are NOT admitted to our hospital and are still under the care of our ED providers.