Our hospital currently implements Epic pump integration with our smart pump, when reviewing NICU CCA, our nurse currently is running any NICU fluids under "IVF plain" or "IVF additive" in the pump, for example, 1/2 sodium acetate with heparin, D5W, D10W...this has caused MAR device not scanned warning on Epic and NICU RN needs to manual entry and set up the pump.

Does your organization have all NICU fluids added to the pump drug library?

We are in the process of developing general guidelines for taking care of MCAS patients with anaphylaxis s/sx admitted to urgent care or ED from our outpatient Allergy clinic.

The key questions are what medications and doses are to be used (e.g. diphenhydramine IVP vs. infusion) and what level of monitoring is warranted.

There is a lack of good quality literature on this subject. I would greatly appreciate any insight or best practices you could share.

Thank you.

Daniel Kudryashov
Keck Medicine of USC

We are seeing more providers wanting to titrate paralytic agents to "ventilator synchrony". Our current titration goal parameter is TOF. What are your default titration goal parameters for neuromuscular blockers?

a) Train of Four
b) Ventilator synchrony
c) other

If titrating to ventilator synchrony, how do you define and measure it? Any additional insight you can provide is appreciated.

Thank you.

Daniel Kudryashov
Keck Medicine of USC

I would be interested in what your policy is if you are using DOACs for pediatric patients. Thanks in advance. Rivaroxaban is our current formulary item. We may add it to our High Alert Medication list soon...

Hello All,
We are re-evaluating our code cart contents in ICU and wanted to ask those that work in hospitals with an open heart program the following:
1) How many beds is your ICU?
2) How many code carts do you have in the unit?
3) How many epinephrine syringes are supplied in each code cart?

Thanks for any information you can share!

Chris

We recently had a request to review and add amisulpride to our formulary by an anesthesiologist. This is a newer medication with a unique mechanism of action in the postoperative nausea/vomiting world. Curious to hear what other health systems are doing:
1) Are your anesthesiologists asking for this medication to be added to formulary?
2) If your System P&T reviewed this medication:
a.What is the formulary designation?
b.Which electronic health record platform are you using?

At our health system, we have a variety pack of order description names for cyclosporine Neoral and Gengraf products that do not always clearly align with the products on the shelf. Although these products are relatively interchangeable, we sometimes encounter procurement, barcode scanning, and delays in care by trying to clarify the intended order vs. what is actually on hand. We are in the process of trying to standardize this practice across our health system and would love to hear how your facility manages this situation.
1) Do you carry both Neoral and Gengraf products?

I wanted to reach out to see if anyone has had a potential solution (even if not perfect) to certain medications not being missed. Obviously all medications are important, but some have more serious consequences that others when missed. This is often complicated by the fact that sometimes the medications are missed due to patient being off the floor, unavailability of the medication on the floor, etc.

Medications that we are particularly thinking of include but are not limited to:

Hi everyone,

I have had some questions regarding etoposide precipitation when a peristaltic pump is used to infuse this drug. However, from what I can find in the literature the language is soft, i.e. "non-peristaltic pump preferred" or "peristaltic pump MAY increase drug precipitation".

I'm wondering if anyone has encountered this previously? If you use a peristaltic type pump institution wide, would you change to a different pump specifically for etoposide? Also helpful to know if you do use this pump type for etoposide with no issues.

Good Afternoon-

Our organization is looking at increasing the role of pharmacists in the assessment of polypharmacy and specifically to start looking prospectively at the medications upon admission that may contribute to falls. Does anyone has a vetted pharmacy specific tool that they can share and has anyone leveraged the EMR to assist with identifying these patients. We have EPIC as our EMR.

Thank you for any information that you can share.

Natalie Zilban