For those that have went through Leapfrog Attestment and require vital signs prior to administration of certain medications what medications have you required nursing to document on? We are just putting this into place and want to make sure we aren't missing anything important. Our first thoughts are on blood pressure medications (particularly beta-blockers), dysrhythmia medication (digoxin, sotalol, dofetilide). Obviously there is a balance here and we don't want to overwhelm nursing with these requirement. I just wanted to see what others are doing.

Thank you!

For those that allow bolus from the bag (continuous infusions) how is this done with BCMA workflow? If bolus from bag doses are not scanned than how does this affect your compliance numbers?

Do other institutions use insulin dose range checking and if so do you use a soft stop with a warning or a hard stop or both? What are your numbers for hard or soft stops? We are considering using 100 units as a hard stop for a single subcutaneous dose and having a pharmacist consult and separate orders for the need for larger doses. Does anyone have anything in place like this and would be willing to share? Thanks,

I'm gathering information regarding ISMP Best Practice 6: Our facility uses glacial acetic acid to conduct stability testing within the pharmacy and I'm told that there is no alternative product that can be used. Do any other facilities conduct stability testing within the pharmacy as well? If so, do you use glacial acetic acid to do so, or some other product-what is that product? If you do use glacial acetic acid, what safeguards do you have in place to prevent errors?

My facility recently had an ER nurse use an adapter to attach a 3ml/300 units Humulin R vial to a 100 ml NS bag for a 1:1 insulin drip. Curious as to if second nurse verifications are required on all insulin orders? And also if any facilities predraw 1ml syringes of Humulin R to keep in Pyxis for drips?

We currently categorize the location of our events by where the patient is located, rather than the location of where the error occurred. We are considering the addition of pharmacy locations within our reporting system to allow better event capture and trending of errors that occur within the pharmacy.

I'm wondering how other sites store Thymoglobulin on the floor? Do you have any safety strategies you use for storage in the fridge? or any special stickers on the IV bags?

thanks!
Stacy

Are verbal orders allowed at your facility and if so are they limited to certain medications?

How can I get a copy of an April 2001 ISMP acute care alert?....it's the one that described an issue with PO and IV caffeine citrate.

Thanks!

Randi

Our health authority currently utilizes 3 different concentrations of norepinephrine: 16 mcg/mL, 32 mcg/mL and 64 mcg/mL.
We’d like to reduce this to one concentration, which will likely be 64 mcg/mL (for fluid restricted patients). Does anyone have any experience using 64 mcg/mL concentration (or similar)? Concerns raised are:
- some patients are sensitive to norepinephrine and only need 0.03 mcg/kg/min (1.25 mL/hr in a 45 kg patient)
- is this too concentrated for a peripheral line start in Emergency, if not added to a Y-site with running fluids?