Hi,
Wanted to get some insight on how other hospitals handle ordering pre- procedure medications? Are they ordered as 'once' orders? or 'once PRN'? We have had some errors in both instances. With the 'once' orders, sometimes these medications get given too early (ie. surgical prophylaxis antimicrobials) but with the 'once PRN' medications, we have had instances where the medication is not given.
Thanks!

Any cardiac centers willing to share their setup/default settings for ordering a titratable dobutamine and/or milrinone here or via fiona.lui@swedish.org

Providers at my institution have proposed that:

-Dobutamine dosing range should be limited 0-10 mcg/kg/min despite Lexicomp's dosing range of 0-20 mcg/kg/min.

-Milrinone dosing range should not exceed 0.375 mcg/kg/min despite Lexicomp's range: 0.125 - 0.75 mcg/kg/minute.

Do you store concentrated electrolytes in your pharmacy carousel? If yes, what safeguards do you have implemented?

Hello,
Can sodium phosphate vials - concentrated electrolyte be stocked in medication rooms in dispensing cabinets. Is there an ISMP reference.

My facilities are ambulatory surgical centers and do not have automated dispensing machines. The OR suites have drawers with open (cup-like) labeled bins containing the various OR medications. Sugammadex is contained in these drawers and would be exposed to light upon opening the drawer. There is potential for extended light exposure if the drawer is left open during a case. The package insert for the medication states that if the medication is exposed to light, it should have a 5 day expiration. How are other facilities handling this?

Hello!

Has anyone partnered with VaxCare for their immunization practices? (https://www.vaxcare.com/?nab=1)

Looking for a larger organization using this program to connect with.... also, curious if you had already incorporated ambulatory BCMA scanning into your practices.

Thanks in advance!
Emily

Our organization is currently using 50 mL of overfill for our pediatric TPNs. We have been finishing about 40 minutes to 1 hour early but this is within the expected flow rate for our pumps. Wondering if we need to increase our overfill.

Hello,

Now that clozapine has removed their REMS requirement, wondering what changes are you now implementing at your institution regarding monitoring labs? Specifically, how are you managing patients who have been compliant but lack documented monitoring frequency due to the absence of REMS tracking?

Thank you in advance!

A couple questions related to potassium replacement protocols:

1) Do your protocols include replacement for potassium values 3.5 or higher? We recently conducted an MUE and observed that the higher potassium values were less likely to be replaced. I think it may be because they don't flag in the lab system as abnormal and the potassium orders are PRN. Is there clinical value in replacing the higher levels for most patients?

For Cerner clients:
2) Has anyone accomplished automation of repeat labs and/or alerting the nurses to a potassium value that needs replaced?

Hello,

Our institution currently has 2 naloxone infusion concentrations:
1. 4mcg/ml (2mg in 500ml)
2. 16mcg/ml (4mg in 250ml) for Narcotic OD

In reviewing resources, both Micromedex and manufacturer package insert recommend diluting 2mg in 500ml and I am trying to identify the reference for the higher concentration.

ASHP S4S lists 16 mcg/mL as the standardized concentration. However, the resources listed in the S4S document do not mention that concentration.