We are seeing an increase in the number of ventilated patients due to COVID and options for maintaining continuous fentanyl infusions with existing pump supplies could become limited. There is some talk about using fentanyl 50 mcg/mL through the standard LVP pump with a lock box for security. From a safety perspective, this is concerning. The tubing volume, with extension sets, could easily reach 25 mL, representing 1.25 mg of fentanyl. While the LD 50 for fentanyl in humans is not known, it is estimated at 0.03 mg/kg (from monkeys).

Thank you to everyone who contributed to and attended today's MSOS Membership Briefing webinar. For the COVID-19 discussion, we were able to pull the comments and questions from the chat box, and we are discussing how to best share that information with each of you. Please consider using the MSOS Discussion Board to continue these great conversations on COVID-19 challenges and other medication safety-related topics.

Thanks so much for all you are doing!
Mike, Chris, and Bob

Hi there
is anyone here from NY?
We received executive order from Cuomo. What people do on inpatient side? Do they start this drug for inpatients for PUI?
Thank you

Sorry if this has been asked already...

Is anyone suspending requirements for independent double checks/MAR dual sign offs to minimize staff entry into rooms?

If yes, what medications have you retained the IDC requirement for? I'm being asked by our Nursing Leaders to consider this and am trying to think it through (and not freak out in the process :)).

Hope everyone is hanging in there!

Today's ISMP newsletter is available on our website at:
https://www.ismp.org/acute-care/medication-safety-alert-march-26-2020
It is freely available but requires a sign on for password if you do not already have one. Mike Cohen

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In this week's issue:

Special Edition: COVID-19

Revisiting the Need for MDI Common Canister Protocols During the COVID-19 Pandemic

Hello,

We are looking at labeling and barcode scanning practices in our ICU settings, specifically around doses of medications manipulated at the bedside (e.g. paralytics, opioids, etc.). What are your practices related to these types of drugs? Do nurses have a standard way to label? Do they scan doses drawn from the vial, using and Omnicell or Pyxis label? Are there different processes for a single dose administration vs. in a bedside procedure scenario?

Any information you can provide would be helpful.
Thank you,

Ashley Van Drunen
Seattle Children's

Hello
Wondering if anyone is willing to share info on their policies relative to CS waste. We had a wrong dose error which was discovered when one nurse was witnessing the waste of liquid morphine. She insisted on seeing the order before signing off the waste and realized the wrong dose was being given/wasted. We have identified that our policy is not specific at all and just wondering if any of you define what a waste is in your policies - there is definitely varying perceptions here of what the means.

Good Morning,
We are wondering peoples thoughts on changing our current ADC log-in from BIO-ID to password? With most people wearing gloves throughout the day, ADC login- becomes a challenge. Cleaning keyboard prior to login in then needed to remove glove to use fingerprint seems to defeat purpose of cleaning. Have others transitioned to user log-in and password?

Thank you for your time and reply,

Jacqui

Please share you medication process/protocol for RSI meds and crash carts. Specifically, are you considering special carts or bags to be used in negative pressure, isolation rooms or COVID-designated OR's to minimize room entries? Has Anesthesia requested anything outside of your usual RSI kit or crash cart? How would you handle the contaminated med kits and unused medications?

What are your med rec techs doing with patients potentially identified but not yet tested or results not back for COVID-19? Our techs are currently 'business as usual' with precautions for these patients and we are discussing what other interviewing options could be used. Our ED rooms do not have telephones so calling isn't an option. Would love to hear how hospitals with more experience tackled this. Thank you.

Carol Labadie
Vidant Medical Center
Greenville, NC