Hello Members,

We are in the process of implementing TNK for AIS and our nursing team would like to know what other institutions do when it comes to administration of TNK in ED and outside ED. Can you share which discipline(s) is/are allowed to administer TNK in ED and outside ED at your site?

We also have a challenge with RN shortage and our current RNs to patients ratio are pretty high; therefore this can impact patient monitoring post TNK. Can you also share what is your monitoring guidelines for TNK if different than tPA?

Thank you for your time.

Manisa

A question was posed to our med safety team about the proper dispensing connection for bladder irrigations. We currently dispense with a catheter tipped syringe to prevent IV administration. The nurses are emptying the solution into a cup and drawing it up into a luer lock syringe to administer into the bladder. Nursing is in agreement about the concern for wrong route errors and not using the luer lock.

Our EHR currently allows pressor infusions (e.g., epinephrine, norepinephrine, phenylephrine, etc.) to be ordered with two different dosing units for adults--weight-based and non-weight based. Currently the default dosing unit is non-weight based, so naturally our using data indicates that is the most frequently used dosing unit (~95% of orders). We are aware that the ASHP Standardize for Safety group has recommended weight-based dosing for these infusions, but there is some concern for change trauma for both our providers and nurses.

Hello - we’ve been experiencing intermittent shortages of lidocaine 5% patches and are considering using lidocaine 4% patches as a substitute. I’m hearing that other institutions only use 4% patches in the hospital setting and curious if the 4% patch used the same way as the 5% patch, i.e., up to 3 patches at a time for max duration of 12 hours within a 24-hour period? Or do you follow the Drug Facts label and use just one patch at a time?

Hello, the excipients sodium benzoate and propylene glycol are on the Kids' List for oral medications in neonates. The concentrations of these excipients in oral products are not on the label, and getting information from the manufacturer is not easy or timely. How does your institution handle this issue?

We are encountering odd issue at our site with discolored acetaminophen injection (pink-ish discoloration). Expected appearance is clear, colorless to faint yellow, per pkg insert. We are actively working through this issue with the manufacturer, but curious if others have experienced similar, maybe with a different lot than we have (below).

Picture featured appearance is attached, but may not be able to read specifics. Including as follows- Product: Acetaminophen 1000mg/100mL bag, Mfg: Hikma, NDC: 00143-9386-01, Lot: 2307123.1

Does your hospital have a policy or having current discussions on a volume cutoff as to where a CSTD should not be used for administration due to significant volume loss?

If you know of literature that discusses this topic, please attach as well.

Thanks!

Hello, our institution previously used a 0.22 micron in-line filter for epidural syringes. However, we are in the process of switching our tubing. The potential new tubing comes with a 1.2 micron filter.

We are trying to determine if this 1.2 micron filter would be appropriate for epidurals.

I would appreciate the group's input on what filter size do your institutions utilize for epidural syringes.

Thank you!

Hello, our institution previously used a 0.22 micron in-line filter for epidural syringes. However, we are in the process of switching our tubing. The potential new tubing comes with a 1.2 micron filter.

We are trying to determine if this 1.2 micron filter would be appropriate for epidurals.

I would appreciate the group's input on what filter size do your institutions utilize for epidural syringes.

Thank you!

Our institution is considering switching to Isovue and Isovue-M for contrast.

Isovue is not indicated for intrathecal use, while Isovue-M is specifically
indicated for intrathecal use. For those of you who already stock this contrast, curious how you ensure that Isovue is not being inadvertently used if an intrathecal injection is planned?