Recently, several questions have come up during discussions with Pharmacy staff regarding appropriate workflow to maintain sterility. I was hoping someone knows the answers to the below questions:

Is anyone allowing use of Kcentra when INR is 1.4-1.99 and patient needs emergent surgery? If so, what dosing are you using?

Thank you

Hi, our institution is discussing utilizing concentrated insulin 4,000units/250mL (16units/mL) for Toxicology (CCB/BB Overdose). We batch all of our regular insulin bags (100units/100mL). For institutions that have implemented the concentrated insulin, what safety precautions have you put into place to ensure pharmacy preparation & dispesning workflows are optimized to prevent confusion between the two concentrations? Switching to premade insulin infusions is not an option currently.

Thanks!
Jaime

Do you use a ramp up ramp down for neonate PN? If so, do you have any sources that I could refer to?
I have found 1 reference that is 12 yo which recommends 50% rate for the first hour and to wean off at50% for the last hour.
Thank you for your help.
Doug Shafer

I would like to alert everyone that Xellia Pharmaceuticals' premixed vanomycmycin bags (VANCO READY) have a warning to not use in 1st and 2nd trimesters of pregnancy. This is due to the excepients PEG400 and NADA used in these bags. There is a warning statement on the bag, but it may get missed. Can you share your experience with this product?

How are other institutions handling baricitinib dose preparation with regards to NG, or G tube administration?

A. Pharmacy staff prepares all oral liquid doses and assigns 4 hr BUD

B. Nurses disperse doses in liquid with PPE in place

c. Nurses crush tablets with no precautions in place.

D. Other options?

Hello,
We are in the process of converting to NR fit tubing for epidural infusions and would welcome any feedback from any institutions who have made this conversion. Any input on lessons learned, what went well, what didn't go well would be appreciated.
Thank you!

Hello - wondering if any institutions are giving lacosamide IV push at your institution? We have had some interest in this route to minimize delays in high risk/seizing patients. There is some literature that has made its way into tertiary resources, but unclear to me if folks are actually doing this (and any experiences to report). Thanks!

We are considering using LET Topical solution prepared by Quva. Main concern is that it is in an oral syringe that could easily be confused with any other oral syringe and accidentally given orally (esp. in the setting of a pediatric emergency room). See image attached.

We have added a dispensing alert when the nurse removes from the ADC.

Curious to know if other institutions are dispensing LET in an oral syringe and what mitigation strategies have you put in place?

We recently had an event at my hospital in which nutritional insulin for tube feeds was incorrectly given when tube feeds were interrupted resulting in a hypoglycemic event. Currently our workflow relies on a manual process involving the changing of a colored placard on the patient IV pole when tube feeds are held. We would like to make this workflow more resilient possibly utilizing our EMR system, we have EPIC. I would greatly appreciate hearing how other institutions handle this. Thank you!