How are you managing heparin drips in COVID patients requiring pre- CRRT filter heparin for access issues as well as systemic heparin for acute thrombosis?

Are you converting to pre-filter only, systemic only or managing both separately? If pre-filter heparin, how do you manage communication when CRRT is held temporarily to ensure systemic heparin is continued?

Appreciate input from your experience related to relevant issues and strategies employed.

Thank you!

Will you share your nursing practice or policy related to concentration changes for continuous IV infusions? For example, if a patient is on a 1:1 epinephrine infusion and is being switched to a 4:1 concentration, how does the nurse set that up? I would assume that the new 4:1 concentrated bag is spiked with a new primary set so there isn't mixing of concentrations in the line--but what about the volume left in the catheter of the access site? Do your policies specify what should be done (load with drug, withdrawal previous concentration, etc.)?

Good Morning,

Just want to see if anyone is using any other IV room workflow solutions that are NOT "BD Cato" or "DoseEdge" products.

Thank you for a reply.

Hello,
Due to increases in COVID-19 related intubations, our intensivists are asking that we load vecuronium and rocuronium vials in our ICU ADS (omnicell). We currently have these vials inside RSI kits, available through override in our ICUs and ED, but they are asking that we build an order panel in our EMR (Epic) that includes the vial for bolus and a drip and have the vials readily available on the unit. Has anyone received similar requests and did you change your process due to COVID--19 related intubations?

Thank you!

Julieth Formosa, Pharm.D., BCPS

Gammagard S/D-Our chemotherapy technicians are reporting multiple instances where the rubber stopper on the 5g vials is pushing through into the vial upon puncture (picture attached). I have reported the problem, but am wondering if anyone else has seen this?

Hello!
We are addressing safety practices related to local anesthetics in the operating room. The question came up whether we should disallow entire vials on the surgical field. I haven't found recommendations to support this beyond use of prefilled syringes. Has anyone limited vials or implemented other processes to minimize adverse events with anesthetics in the OR? Primarily concerned with surgeon giving higher than recommended doses.

Thank you for you input!

For anyone using clinical survillance tech (e.g., Sentri7, VigiLanz, etc.), in addition to the fundamentals, what rules have you built for ADE monitoring/prevention? What cost savings, regulatory, or less common rules have you been able to create to enhance patient care and data capture?

We are evaluating the pros and cons of implementing infusion pumps with interoperability. If you have implemented this technology, please share the following:

1) What have been the pros of having interoperability of infusion pumps in your facility?

2) What are the cons or what downsides have you noticed post-implementation?

3) Has utilizing pumps with this technology increased safety in your organization?

4) What would you have done differently?

Thank you in advance for your input.

Currently oral morphine 0.4mg/ml is dispensed to the neonatal unit pyxis drawn up into 1ml sringes with a barcoded label. When needed for Neonatal Abstinence Syndrome the nurse will waste the drug not needed and administer the appropriate dose as needed depending on the scoring. We have tried to draw up a patient specific dose but it never works because we can't get the dose to the unit in a timely fashion. What are other units doing?

What is your default administration rate for IV fluids ordered as "bolus"? Is the infusion rate part of the order inputted by the ordering provider, or driven by nursing or pharmacy protocol?

In our system, the order is placed with an infusion rate of "bolus." For example, "0.9% sodium chloride, 1000 mL, IV, bolus" and the pharmacy staff assign a specific rate during order verification, like 1000 mL/hr, 500 mL/hr. I am wondering if anyone is doing this differently and would appreciate anything you could share regarding this practice.