We had a recent issue where a patient had 2 appropriate heparin flush orders for different concentrations (for different types of line). We identified some gaps which is leading us to take another look at safety processes around storage of heparin flush for patients requiring different concentrations and/or different patients requiring different volumes. We want to minimize nursing manipulation with the use of several syringes just to obtain the desired volume.

We learned recently that there is a change in concentration for rabies immune globulin from Grifols (HyperRAB). The company told us that the product will now be 300 units per mL and not 150 units per mL as was the case with the previous formulation. Note that the 150 units/mL is still available for now but is being phased out.

Reason for the change to the higher concentration is to allow for less volume per injection into the area surrounding the wound. The dose is weight based (see package insert).

I am wondering what other hospitals have put in place to reduce wrong route administration errors with orders to administer atropine eye drops orally to reduce secretions. Is anyone placing in a different container?

Appreciate any insight you can provide. Thanks!
Jen

My name is Barbra Fobi an ISMP fellow. I am currently working on the question “what is the safest way to express doses less than 1 mg (e.g. 0.057 mg or 57 mcg)?” In addition, is there a safer dose expression when crossing a metric threshold (i.e. 1000 mcg or 1 mg)?” Presently, ISMP’s Draft Guidelines for Safe Communication of Electronic Medication Information #9 addresses trailing zeros, leading zeros (e.g. 0.3 instead of .3) and commas but not these specific concerns.

I'm looking for some feedback on how other institutions are dispensing pharmacy-compounded syringes for inhalation. Some examples we're dispensing here are: amikacin, albuterol, amphotericin B, polymyxin B, and colistimethate.

What syringes are you dispensing in? (IV vs. oral)

Do inhalation syringes (other than the 60 mL Aerogen syringe) exist? Specifically, smaller volumes?

Any other additional preparation steps to ensure proper administration route (labeling, bagging, etc)?

Thanks!

If you use bottled sterile-water-for-irrigation for reconstitution of oral powders, when do you discard the bottle after opening? Single use? 24 hours?

Thank you for any info you can provide!

Very respectfully,
Jane Mauro

Does anyone have a hospital policy on self-administration of medications or administration by family members that they could share? We've had patients and family members wanting to administer medications and I am looking to address this in policy.

Thank you,
Madiha

HI All,

I have been to Susan Scott's presentation on Second Victim support. I attended with a pharmacist colleague who is a second victim. Right now, I am at ASHP in the peer support program right now.

My colleague and I spoke about having a support page for pharmacist second victims, so I created a SECRET group on Facebook. You can't see it. I have to INVITE them. If someone who is a second victim would like to join the group, have them contact me through FB.

If you have worked in this space and want to share the moderator role with me, reach out to me.

Is anyone willing to share their experience with various technology to automate/track your medication carts/kits, especially as regards accuracy and safety? I am especially interested in pro's and con's for the type of replenishment system that electronically scans/evaluates a whole tray at a time and e-validates placement, exp dates, correct med, etc.

Hello! We are a pediatric hospital within a larger adult hospital and use Omnicell as our automated dispensing cabinet. We've found that liquid controlled substances are particularly difficult for tracking patient-specific doses from the Omnicell, and the system seems to want a "stock dose" to be dispensed; however, since we strive to dispense other liquids as patient-specific, I'm worried that this introduces a risk for errors in administration. Does anyone have recommendations for how they are handling patient specific liquid doses from the controlled substance Omnicell? Thanks!