I know this topic had been discussed a few years back, but I wanted to repost in case anyone has any new experience/knowledge on the topic. Has anyone operationalized an opioid assessment for tolerance, and if so, who does the responsibility lie with - the physician, the nursing staff, or the pharmacy? Is that assessment used for prescribing? Also, if anyone would be willing to share what their assessment looks like in the EMR it would be appreciated!

Thanks,
Michelle Heidel

Hello,

What does your organization use as a required time for administration, waste, or return of controlled substances?

Do you have exception to policy for procedural use?

Would you mind sharing your policy?

If you don't require a time, do you have an alternate strategy to mitigate risk of diversion?

Thank you!

Jeff Schnoor, Pharm.D.
Medication Safety Coordinator
UVM Medical Center

How do you manage sickle cell patients on long acting opioids when a provider wants to start PCA? We have a provider advocating that the patients stay on their long acting opioid and add PCA without a basal rate to use for breakthrough pain. She feels this is safer than stopping home opioids and trying to convert to IV with a basal rate.

Our current policy says no additional opioids with PCA so she wants an exception made for these patients.

Thank you!

Carol

I am looking to increase compliance in tracing the line (bag -> pump -> patient). So far we have placed small laminated cards to the pump, and daily huddles. It's not working. The system we use is Meditech and pretty much frozen from build as we are switching to a new EMR. I have a RCA coming up and would like to learn different opportunities you do to ensure nurses trace the line. Any insight greatly appreciated.

I'm at an EPIC based hospital, and have encountered a couple of safety events relating to patients admitted with an implanted intrathecal pain pump that is managed in the outpatient setting.

- Do you have a policy for implanted pumps (can you share)?
- How does your facility document the implanted pump? Are drug specific orders placed and is it charted upon in the MAR?
- What's your process to adjust the infusion rate or turn off the pump if an adverse drug event occurs?
- What requirements do you have for notifying the outpatient prescriber of the pain pump?

We have seen a number of reports from Nursing staff regarding repeated occlusion alarms when running Ketamine infusion via the Alaris Syringe-pump module using a 30 mL syringe. The concentration is 5 mg/mL. Our theory is this may be due to the concentration of the medication.

If applicable, how are ketamine infusions administered at your institution? What concentration are you using? Have you seem a similar issue with occlusion alarms? Thank you!

I am gearing up for my 3rd medication safety student and am overall very excited about the opportunity to share my passion for medication safety with the next generation of pharmacists. For anyone who also has established an elective medication safety APPE rotation, would you be willing to share your "course objectives" or syllabus for your rotation? As a small rural hospital pharmacy director, I am by no means a "Medication Safety Officer" but feel that our setting is still very conducive to learning about medication safety. Are there any articles, books, videos, etc.

Do any sites have a nasal decolonization protocol? Even without a formal protocol, what products are you using?

I am currently evaluating between providone-iodine and alcohol based products, but of course, there are no head-to-head studies. Seems like either would be fine, but would be interested if someone has info showing superiority or why you went with a particular product.

TIA!

We're revisiting ISMP's recommendations on topical thrombin. What precautions has your facility put in place to prevent IV administration? Does your pharmacy prepare doses?

https://www.ismp.org/sites/default/files/attachments/2018-03/20170112.pdf

Thanks!
Joanie

1. For surgical prophylaxis in the OR, are your providers administering cefazolin IV push or intermittent infusion?

2. If intermittent infusion, what is the typical infusion duration at your site for anesthesia's purposes?

3. We are avoiding IVP due to some cases of serious ADR's but considering logistical concerns with a 30 min infusion which is our standard build outside of the OR setting.

4. If you made a switch from IVP to intermittent infusion, what was the rationale for that change at your site?