In updating our LASA system-wide policy, we have considered adding morphine oral liquid concentrate and morphine non-concentrated liquid. This pair is on ISMP's list of confused drug names. However, opioids are on our high alert medication policy. We were wondering if that's enough? Does your organization include this pair in your LASA policy? What strategies do you use to prevent a mix-up between these drugs in the ambulatory and acute care setting?

Hello all, we are currently experiencing difficulty obtaining IV digoxin for our pediatric and neonatal patients and are looking for guidance on oral alternatives. What are others currently using? If you are compounding, do you have a recipe that you are able to share? Any help is greatly appreciated!

Warm greetings!

Does your facility's order set for Stroke alteplase orders also include reversal agents for angioedema?

During my facility's stroke survey, the surveyor recommended adding reversal agents for angioedema as part of the standard Stroke Thrombolytics Therapy order set. She stated there is an increasing incidence of angioedema (1 to 5% incidence) with alteplase, most notably in patients also on ACE Inhibitors.

We are in the process of implementing USP 800. We are using peridox to decontaminate our bags prior to dispensing. We are finding some of the labels are holding after dispensing. We are waiting for the peridox to dry prior to labeling. Does anyone have a better process?

Do pharmacists do an independent double check on pediatric doses prior to dispensing? Is this pharmacist IDC on all doses or do you specify only high risk meds, only hazardous meds, etc.? If standard procedure is a double check prior to dispensing, how do you handle shifts when there is only one pharmacist such as overnight? Any insights, policies or SOPs would be greatly appreciated.

Thank you

Has anyone heard from their nurses that they are having issues with albumin running with a vented administration set? Was it an issue with the administration set itself or with the way the nurse was connecting the administration set and albumin?

What were some successful ways this was resolved?

Hi there!

We had an recent concern escalated from our Children's Hospital around the dispensing of LORazepam from a retail pharmacy setting when it comes to sedation weans. (Children that had been on long term sedation in the ICU setting may require a somewhat prolonged wean from their medications, even at discharge.)

My institution is revising our policies related to IV therapy/infusion pumps but struggling to find the right language to mandate smart pump use for majority of infusions, but have specific/appropriate exceptions for scenarios when pumps are not used (eg. needing to give faster than the pump will pump (>999 ml/h), pressure bag use, limited/specific items given by gravity). Any examples of policies that people have would be helpful to reference as we are updating ours.
Thanks!
Katie Johnson
(katiejohnson@uky.edu)

Hello,

We recently had a near miss event at our institution where 2 patients with the same name (one Jr, one Sr.) almost received medications intended for the other patient.

Upon review, one of the gaps we identified was that the patient suffix does not display for nurses on Pyxis ES console. According to our BD Carefusion representative, the patient suffix information is transmitted over to Pyxis, but is information only and cannot be displayed for nursing at the console.

We are re-evaluating our guidance on Metoprolol IV. We are trying to find something that will work for all of the hospitals in our system, which have different acuity of patients. I would love to hear from you regarding what limitations, if any, you have on Metoprolol IV.

-Do you allow metoprolol IV on general units?
If yes, do you have a restriction on dose/frequency/number of doses/delivery/etc?

What standard monitoring is required?

How do you enforce your restrictions?

Any other pearls would be greatly appreciated!