Interested in learning about safeguards that facilities stocking the phytonadione
1 mg ampule product have put in place.

General concerns we have identified at this point include:
1. mix-ups with phytonadion 10 mg ampule
2. mix-ups with methylergonovine ampule

Appreciate any insight to safeguards or risks you may have. TIA!

I am part of a 500+ bed, urban, academic organization. As far as antibiotic infusions go, we currently only run Zosyn as a primary infusion (run over 4 hours); our other antibiotic infusions are run as a primary/secondary set up. During the normal saline shortage, we ran all antibiotics primary and flushed with a 10 mL flush post infusion. Now that we are able to go back to our primary/secondary set up, we are getting some pushback from nursing.

How does your organization infuse IV antibiotics?

How do you draw up a patient-specific dose of an inhaled med? It is my understanding that the product needs to remain sterile, therefore doses should be drawn up in an ISO Class 5 environment into a sterile syringe.

1. Are you drawing up inhaled meds in your IV room hood?

2. Do you dispense them in an IV syringe, or an oral syringe?

3. If you do use oral syringes, are you using a STERILE oral syringe? If so, what manufacturer are you using? (Looking for sizes up to 10mL)

thank you for taking time to respond!

The package insert Westward brand injectable morphine specifically states 'for intravenous use' / for 'direct IV injection' - there is no reference to IM or subcutaneous routes.
https://www.accessdata.fda.gov/drugsatfda_docs/label/2011/202515s000lbl.pdf
I'm soliciting feedback and rationale on whether the IM or Subcutaneous routes could be included in an EMR build (or not).

Curious to see what type of MRI compatible infusion pumps other hospitals are currently using? We are using IRadimed pumps at our facility.

Thank-you in advance for all who comments, much appreciated.

Natalie Zilban
Medication Safety Officer
Memorial Healthcare System
Hollywood, FL

We are standardizing our RCA process across our health system. Initially we are requiring all sites complete an RCA for SREs (at a minimum). Eventually I'd love to expand this of course.

As you are probably aware the SRE definition for medication-related events is pretty generic. It is difficult to define "serious injury". Also, I would like to include events where a lack of monitoring led to serious injury, even though it is not technically covered by the examples given.

Has anyone developed or implemented a way to make the age of a medication on the history (when it was last entered or updated) visible to clinicians (MDs, RPhs, RNs, NPs, PAs, CPhTs)?

If so, has anyone incorporated alerting to the prescriber on reconciliation based on the age of the history being reconciled?

Since we are an EPIC shop, any insight or experience with a "Med Rec Module" for EPIC would also be most appreciated.

Regards,

Michael Van Ornum

At my organization, IV push paralytics are administered by nurses in a couple of defined situations, RSI and suppression of shivering in hypothermia patients. We have heard that Joint Commission has cited facilities that allow IVP administration of paralytics by nurses. Has your organization experienced regulatory challenges related to IVP paralytics? Do you have policy that limits who can administer a paralytic?

Hello all-

I have a question regarding how sites are ensuring safety with propofol.

1. Do you limit where it can be used?
2. Do you restrict access in the ADC to prevent diversion?

What else have you guys put into place to prevent errors and/or harm.

Natalie Zilban
Medication Safety Officer
Memorial Healthcare System
Hollywood, FL

For pediatrics we occasionally need tiny doses such as 0.25 units of rapid acting insulin. Since we cannot draw up using an insulin syringe, we are evaluating the process of diluting insulin with the sterile diluent from the manufacturer. Something we have encountered is how to best order and discuss the dose, once diluted. In pharmacy we tend to think of 0.25 units as 0.01 mL (of 25 units/mL diluted insulin). When our Endocrinology team is reviewing with patients, they tend to refer to this same dose as “1 unit of diluted insulin” to visualize the marking on the insulin syringe.