For hospitals with a cath lab, how many staff members are in the room during the procedure? As a high-alert medication, does heparin require dual sign-off when staff are operating under a provider's supervision (i.e. nursing) at your institution? If your institution does not require a dual sign-off, what electronic safety feature(s) do you have in place? For reference, our EHR is Epic, and we are not currently utilizing barcode scanning in the OR.

Dear MSOS colleagues:
I would like to clarify if you keep Concentrated (Undiluted) Magnesium Sulfate 50% vials in the non-cardiac operating rooms automated dispensing cabinets (ADC)
as per the JCI IPSG, (IPSG 03.02), Improve the safety of medications (concentrated electrolytes)
"The exception to store concentrated electrolytes outside pharmacy in patient care units is the availability of magnesium sulfate in the cardiac surgery kit and cardiac surgery locked storage areas, emergency carts and where patients with preeclampsia treated"

Hi

Phytonadione vials and ampules for neonates are significantly cheaper than the preservative-free syringes but contain 4.5 mg of benzyl alcohol per dose.

The American Academy of Pediatrics and the CDC are fine with the minute amount of benzyl alcohol, but our providers are worried about parents refusing the dose because of a perceived danger from the preservative.

Would you mind answering this brief, 2-question survey, so we can get a feel for what other hospitals are doing?

Anyone willing to share their organization's policy on maintaining medication fridges?

1) How frequently are they cleaned?
2) Who cleans?
3) Is that individual different in ambulatory areas vs acute care areas?
4) What all does the cleaning entail?

Thanks,
Sloane Hoefer
Nebraska Medicine

We are a large institution that serves both adult and pediatric populations. There are several injectable medications that are used off-label and given via inhalation (given by respiratory therapy).

How are other institutions dispensing these medications for use? Do you draw them up in patient specific doses or do you dispense products as a unit dose vial and allow respiratory therapy to draw up the dose and administer? If you are drawing them up, how are you sending them to avoid administration via the wrong route (Intravenous)?

For 340B hospitals:

How are you dispensing misoprostol 25mcg for cervical ripening? Since it is hazardous, are you splitting and packaging in the pharmacy or are nurses cutting a 100mcg tablet on the floor?

Since it is off-label, I don't anticipate a 25mcg product ever becoming available.

Seeking input from other institution's policies and hardwired safeguards regarding early administration of narcotic PRN medications. Concern that early administration may lead to dose stacking and potential for oversedation/respiratory depression esp in vulnerable populations (opioid-naive, geriatric, etc).

Example: Example: Hydromorphone 0.5 mg ordered q4h PRN. If administered every 3 hours instead of every 4, the patient could receive two additional doses (1 mg) within a 24-hour period.

Hi All

Has anyone had any ADRs associated with IVP venofer? If so, what were the reactions? What have you done to prevent?

Thank you

Does anyone have a good process in their EHR to manage orders for, dispensing of, and documentation of provider administered intra-articular injections on a med-surg unit?
We had a recent scenario where the provider entered the order as IM instead of IA, and the med went to the MAR giving the impression that the nurse was to administer it IM.