How is your organization handling respirators? For example, if a CSTD is being used during IV administration of those medications that have the potential to vaporize at room temperature (i.e. carmustine, cisplatin, cyclophosphamide, etc.) are your nurses using respirators OR are you considering the CSTD the protection? Are you just using PAPR type respirators in the event of a spill? I appreciate your guidance!

Stacie Ethington, MSN, RN-BC
Medication Safety Nurse Specialist
Nebraska Medicine

Greetings - If you use a bladder instillation cocktail consisting of triamcinolone, heparin, lidocaine, gentamicin, and sodium bicarbonate in NS, are you able to share your BUD and the reference? Thank you.

We are in the process of implementing interoperability between smart pumps and EMR. During this process we have identified that our EMR is setup to have a dual verification for chemotherapy rate changes. This is not something that was forced before but when completing the pump rate verify it ask for each rate change to be dual verified.

The standards from ONS suggest a dual verification for initial pump programming but do not go into detail regarding rate changes. APON suggest a dual verification for initial pump programming and rate changes of chemotherapy.

What safety strategies have people employed to prevent tubing mixup for TPN compounders? See brief description of our event below.

Has anyone successfully used the "shrink wrap"-type vial covers for any of their high-alert medications? For reference, I was looking at the product available from Healthcare Logistics: https://shop.gohcl.com/default.aspx?page=item detail&itemcode=16063

We are specifically considering them for use with our neuromuscular blocking medications, as applying labels to the vials is problematic space-wise.

My concern is that it looks like the shrink wrap could possibly cover important vial labeling information.

Hello,

We are hoping to learn from other pharmacies who compound autologous serum eye drops for ophthalmology patients. If you are currently preparing these drops following USP 797 standards, would you mind sharing your written procedure or provide an overview of your process?

Thank you,
Crystal

Crystal Holmes, PharmD
Pharmacist Practice Leader, Regulatory Compliance

It has been a while since this topic was posted here.

What safeguards is your institution employing to enhance safety when topical epinephrine is used for ENT cases?

Are you repackaging epinephrine in a pour bottle? If yes, what sterile container are you using for that repackaging?

Hi all,
we currently have ketamine on override in Automated Dispensing cabinets in ED only. We have had a request to add to ICU on override.

Wondering if other folks have ketamine on override in ICU and if so,
1- are nurses allowed to administer ketamine, and
2- do you have safeguards around the withdrawal of this med (witness, alerts, etc.?)

Alternatively if you do NOT have ketamine on override if you can share thoughts or how you handled any pushback.

Thanks in advance!
Dana Miller

I can't find a great answer to this.

What techniques do your institutions use when the OR needs to open a vial to spread the powdered contents into a bone cement? Are there any tools to ensure aseptic technique? One of the nurses mentioned hearing about a catheter, but I can't seem to find anything.

Hello,

Has anyone completed the gap analysis tool? I'm curious to know whether your institution required you to obtain IRB approval prior to completing the tool. Thanks,

Jennifer