It appears that our interventional radiologists use nitroprusside diluted to a concentration of 100 mcg/mL and adenosine to 10 mcg/mL for intracoronary administration. Does anyone prepare this for them or do your providers mix it as immediate use? Anyone have any other safe suggestions (e.g. use of kit or something like that)?

We recently discovered that our Nuclear Med techs are drawing patient's blood, mixing with 100 units of heparin to prevent clotting while they prepare for procedure then inject back into the patient. They also use heparin when centrifuging to tag white blood cells. There is no second person validation that the correct amount of heparin has been drawn up and no documentation that patient received heparin. Our Radiology NM is new to the position and is wondering what practice other facilities are doing with these processes?

Second attempt - any feedback and help is greatly appreciated!

We have a situation that has recurred several times, and we struggle with it every time.
Currently, there are no insulin pumps that have settings based on U-500 insulin. Periodically, we have patients who come in with U-500 in their pump, so their pump settings do not accurately reflect the number of units they are receiving. How do we document this pump in the EMR? We try to move away from their pump to our medications, but that comes with conversion issues as well.

We are currently performing an FMEA on change to a room-service food tray delivery model and impact on medications that are timed with food (most obviously insulin).

Looking to determine how other organizations have handled/adapted to scheduled insulin administration times & documentation when meal trays are delivered via a room-service model where meal times are no longer standard.

Thanks!

Don McKaig
Lifespan--Rhode Island Hospital
Providence, RI

Hello,
How does your organization prepare for procedures for known drug addicts in recovery and scheduled for a procedure, such as a Transespohageal Echocardiogram (TEE).

What meds are used to sedate? We generally use fentanyl and versed however that does not work for these individuals.

How do you identify this patient population to avoid giving opiate/narcotics,

Does your EMR alert providers?

If you have process or guidelines you are willing to share that would be most appreciative.
Thank you

Hello all,

In light of news of the fatal medication event from Vanderbilt University Medical Center, I was wondering if any of you can share some error-reduction strategies you have in place at your institutions to prevent similar mix-ups. I have several to share but would like to hear from the group.

Can you describe your process for tracking/monitoring controlled substances that leave the hospital for transport (i.e. your transport team goes to pick a patient up and bring back to your hospital).

Thanks.

Good afternoon,

Do you have a policy that guides nursing for PRN medication timing? How soon can they give the next dose ie 30 min early for say a q4 hr prn order? Do you have it mapped out for each interval ie q1 hr prn vs q2 hr prn etc?

Many thanks in advance!
Jeanette Dean

Does anyone have a policy or standard of practice regarding driving after receiving sedating medications? For example, patients are advised not drive for so many hours, or are not allowed to drive themselves from the hospital? We are seeing this more in the ED setting and this stirs up nurse/pharmacy debate about how long the patient needs to be kept before discharge if they do not have any other means of transport.

Thanks!
Courtney

I'm hoping you can help provide some corrective actions based on an error we had:

A patient with ongoing rejection of kidney transplant was receiving filgrastim. Once the white count improved the team had asked for the filgrastim to be discontinued (was getting it 2x/week) and it was not recognized that it was not actually discontinued.
The patient went on to receive two more doses and ultimately the WBC count rose to 59K