There is lots of discussion in our Health System related to a change from Normal Saline to Lactated Ringers as the most commonly used base fluid due to literature that shows balanced fluids are superior to crystalloid ones in some outcomes.
Have other hospitals made this change and found a good process for education / tool for nurses around the incompatibilities of LR with certain medications.

Thanks

For those that listened to our Member Briefing webinar today and would like to hear more about independent double checks for subcutaneous insulin, you might want to listen to a previous brief given by Greg Burger in December of 2017:

https://register.gotowebinar.com/register/5787674558169084418

(click "register" and it will bring you to the recording)

Hello,

I am looking for tips on how other sites are implementing or are practicing the demonstrated competency for personnel training in USP 800.

Who at your site is responsible for developing or managing the demonstrated competency for each department?

Hello,

Have any hospitals removed combination opioid-acetaminophen products from formulary and have any pearls for how to minimize risk in transitions of care? Our P&T committee is broadly supportive that these products increase risk of cumulative acetaminophen toxicity and don't allow for optimal pain management and it is relatively straightforward to use alternatives for new starts inpatient. The major barrier/pushback is with patients taking these products at home and minimizing medication reconciliation errors on admission and discharge.

Interested to learn what EHR programming settings you have in place for re-timing medication orders?

Is this a task exclusively managed by a pharmacist or do you allow nurses the ability to retime? If nurses can re-time, are there limits on how many subsequent administration times can be adjusted (e.g., 1 at a time vs. duration of order), time duration from original due time the re-timing can be, etc.?

Good morning,

I was at a hospital last week that uses the Yale protocol for non-DKA insulin infusions and the protocol is so complicated that titration adjustment errors occur, even when two nurses are double-checking every aspect of each dosage adjustment.

If anyone is using a relatively simple but effective insulin protocol can you please post?

Thanks,

Dan

Our hospital/clinics are in the process of standardizing smart pump libraries and we wanted to see if other institutions have put investigational drugs into smart pump libraries. It would seem challenging given the frequent updates that would be needed and the unique features of research drugs. Has anyone successfully created and maintained investigational drugs in smart pumps? If so, could you share what types of pumps you have and any challenges/lessons learned?

Are your insulin gtt rates assigned a max rate per policy?
Do you require provider notification if the protocol rate will exceed any predetermined value?
Thanks for your feedback.

Does anyone have a protocol they are using and would be willing to share? We find that patients are admitted for other reasons (for example, deep seated infections) and we don't have a standard approach to treat their withdrawal. Sounds like an excellent resident project!

Do you allow the use of topical tranexamic acid for nosebleeds at your institution? If so, is the medication supplied in such a manner as to prevent erroneous systemic administration?