We are in the process of evaluating our medication administration guidelines that were historically developed for the inpatient setting and how they are applied to the ambulatory infusion setting.

For example (in the infusion center patients may receive alteplase lock flushes (Cathflo), but not alteplase infusions or bolus doses).

Does your institution have drug specific guidelines for the ambulatory infusion setting or a policy/guideline with guiding principles for what can safely be administered in the infusion room setting that you would be willing to share?

We have gone live with Epic smart pump interoperability and are facing challenges with our overfill settings due to a required utilization of multiple fluid manufacturers due to shortages and the differences in overfills. We are receiving reports that RNs are running out of volume to be infused, with some volumes short by ~20mLs. What have your sites done in the face of these fluid shortages on the Epic build side?

Thanks,
Jeff

​1) Are proposed orders for chemotherapy (IV or oral) allowed at your organization?
2) If so, which position types may propose chemotherapy orders (RN, PharmD, etc.)?
3) Does the policy/practice with proposed orders differ between inpatient and outpatient locations?

Thank you,
Daniel

How do you handle crushing/tubing meds? Currently running into the problem that some meds cannot be crushed based on PK, others can be crushed/opened but it will clog the tube, and some are hazardous and may be crushed but require safety precautions. We currently have a tube feeding guideline that was created by pharmacists years ago with information on crushing and tubing, but since it is not entirely comprehensive and has not been approved by the system we cannot link it in the MAR.

Thanks!
Merissa
MSO-Mayo Midwest

When you compound your chemotherapy preparations, do you account for overfill vs the final labeled volume?
1. Remove "estimated" volume of overfill.
2. Add "estimated" volume of overfill to the final volume on the label.
3. Pump bags to exact base fluid volume stated on the label.
4. Do not account for overfill in the final volume stated on the label.

Hello everyone,

In the past ~ 60 hours our organization has experienced three events of rapid over-infusion of a medication utilizing BD/CareFusion Alaris infusion pumps. Initial investigations indicate that the pumps were programmed correctly according to the medication orders and a crosscheck with Epic/Alaris Interop. Thankfully all three patients have avoided serious harm.

There is suspicion for a pump malfunction, which is being escalated. We are working with the vendor and implementing mitigation strategies across the system.

Hello everyone,

In the past ~ 60 hours our organization has experienced three events of rapid over-infusion of a medication utilizing BD/CareFusion Alaris infusion pumps. Initial investigations indicate that the pumps were programmed correctly according to the medication orders and a crosscheck with Epic/Alaris Interop. Thankfully all three patients have avoided serious harm.

There is suspicious for a pump malfunction which is being escalated. We are working with the vendor and implementing mitigation strategies across the system.

Hello All,
I am curious as to how others are sharing pertinent information from the ISMP Alerts to all staff members. Our Medication Safety Subcommittee was reviewing the Targeted Best Practices and wanted to develop a process to address best practice #14 specifically to share external stories with all staff. Could you please share your processes surrounding this best practice?
Thanks so much!

Cicely Williams,PharmD.

For those that have converted to ENFit or are in the process, how have you addressed the clogging caused by crushing medications. ENFit has a smaller lumen so it is harder for crushed medications to pass through the tube.

Have you made changes to limit which medications you crush at your institutions? Have you had success with any pill crusher which prevents clogging?

Looking forward to hearing how you are handling this situation.

Thanks!

HI All,

My organization has a 35+ year old EHR and it was "boxy but good" to quote the movie actor. It was a mainframe with GUI applications but pharmacy worked in the blue mainframe called VISTA - we could see everything. It was fast and was molded to the highest possible functionality for medication safety (like fully integrated with safety checks in our mail order pharmacy, very sophisticated clinical rules, etc.).