For those out there that use EPIC; have any of your organizations turned off/disabled the foundation build HOLD functionality from the orders activity? There are concerns of how easy it is to put a med on hold indefinitely vs. say a policy that requires meds to be discontinued if held for > 1 dose.

Wondering if any of your facilities require a separate PCA competency be performed prior to allowing residents authority to order PCAs

We are a teaching facility and have high input of new medical staff. We started this program prior to full implementation and optimization of CPOE PCA ordersets and alaris library and are starting to wonder if the return on investment for separate training is still justifiable.

The training program is quite labor intensive and is having trouble getting all new staff competency checked prior to them starting their rotations.

Does anyone have limitations to who can reconcile, update or add new allergies to admitted patients? and what fields are required? Currently we have 3 fields required: allergy type, severity and reaction and in an assessment found we never had all 3 documented. Looking to improve our process by creating a policy.

thanks,

Jess

All,
I am interested to see how hospitals are complying with JCAHO's National Patient Safety Goal 03.06.01: "Compare the medication information the patient brought to the hospital with the medications ordered
for the patient by the hospital in order to identify and resolve discrepancies.
Note: Discrepancies include omissions, duplications, contraindications, unclear information, and changes. A qualified individual, identified by the hospital, does the comparison."

We are in the process of refreshing educational content targeted at our new and existing pharmacy managers. Our goal is to provide clear guidance, with examples, as to how to follow up on a medication event. This will include expectations for documentation in the reporting system, and how to follow the just culture algorithm. Our plan is to use a case-based LMS module to deliver this. Has anyone developed something like this for your pharmacy staff or managers? Any ideas or experiences with this you are willing to share?

Can anyone share what their facilities have in place to comply with targeted best practice #9? It states -

- Ensure all appropriate antidotes, reversal agents, and rescue agents are readily available. Have standardized protocols and/or coupled order sets in place that permit the emergency administration of all appropriate antidotes, reversal agents, and rescue agents used in the facility.

- Have directions for use/administration readily available in all clinical areas where the antidotes, reversal agents, and rescue agents are used.

Thank You in advance!
For context, we use Cerner and are trying to standardize titrations across all our acute care hospitals.
Three topics seem to need more clarity and I am hoping to get information from this group while keeping us JC compliant:

1-range goal parameters. A facility wants to use a minimum or maximum goal versus a range goal. Verbage does not include down titration instructions as well. Also should there be separate order verbiage for absolutes (when to call provider and/or when to turn a drip off - or does a policy support that practice)

1) Does your health system require subcutaneous insulin and heparin to be double checked by two RNs independently prior to administration?
2) If so, and also an EPIC customer, do they document the double check as a double RN verification activity (i.e. type in the name of the 2nd RN) or a double signature activity (i.e. requires 2nd RN to log in) on the MAR.
3) If a double signature is required, do you use any other technologies (e.g. Imprivata badge tap) to speed up the process of obtaining a double signature.

Hi everyone. Does anyone have a protocol on specific medications that can not be administered through a midline? We have the general ones (vasopressors, TPN) but are now being asked to come up with a more specific list with other IV meds such as antibiotics. Thanks in advance!

Our patient safety team is investigating opportunities to improve medication administration. We wanted to see what other organizations were doing in the operative setting. Is barcode scanning limited to nursing use and nursing units only or are you having anesthesiologists/providers engaging in this process? Looking forward to your feedback!