We have a very detailed nurse drive potassium protocol and have experience some errors. A few questions for anyone willing to share how potassium replacement is managed at their institution:
Do you have
1) nurse driven protocol
B) providers enter specific orders for replacement
C) other

Two other questions, do you allow:
D) IV potassium on override
E) Different replacement goals depending on unit

Thank you,
Carey Estes, MSN, RN, CPPS
Manager Nursing Quality - Medication Safety
Mission Hospital
(828) 213-1606

1. Has your organization considered the use of the Alaris pump syringe adapter infusion set / or are you currently using it?

2. If you are using it, was infection control approval obtained? Are the sets used for multiple doses or single use only?

3. If you have considered it but decided not to use it, what was the reason?

4. If you don't use it, would you consider recommending use by your organization? See attached images.

Thank you,
Vidya Saldivar
Medication Safety Specialist
Houston Methodist Hospital

Hello. I am new to this group and appreciate any and all advice. We have the ICU Medical Sapphire PCA smart pump. We are finding that our rate of delivery for patient/clinician boluses at 125cc/hr is slow and causing patient's to be locked out of their potential boluses (demand dose).

Am wondering what other places are using in their PCA pumps for rate of delivery of the boluses and demand doses and/or any advice on the topic of what is considered a safe rate of delivery for the usual opioids: dilaudid, morphine, fentanyl and methadone.

Hi all -
We will be doing an Epic upgrade at the end of this year to the 2018 platform. Today I was made aware of "fuzzy logic" that will be incorporated with this upgrade. Fuzzy logic has to do with all orders (not just medications) where if the end user has a typo or spelling error, medications will be suggested. An example is Laxis - Lasix will be found. However, another example is Duno - both daunorubicin and doxorubicin will be found. But if you don't have one both on formulary, only the existing one on formulary will be found.

I am exploring the potential of secured storage of controlled substances in our PACUs. Fentanyl, as an example, is often given in increments of 25 mcg or 50 mcg every 5 minutes PRN severe pain. If the RN vends 100 mcg, is it always handled as a single use item or is the remainder conserved in a secure fashion for future increment doses? If yes, how do you ensure integrity in the chain of custody and what processes are in place for reduce the potential for diversion and/or to detect diversion?

Due to the shortage of bupivacaine 0.25%, we were wondering if anyone was diluting bupivacaine 0.75% for OR use.
I am trying to find out stability data.

Thank you

Hi,

If a patient is transferred to a different level of care (for example, from intensive care to a standard room), do you require that medications be reordered by a prescriber? If so, how do you accomplish this without creating errors of omission?

Thank you,
Dan Sheridan

Hello,
How do you handle patient intrathecal pain pumps that go empty during prolonged hospital stay. They may be admitted for another medical problem and they miss their appt. to refill pump and without the medication(s) their pain is not controlled with IV pain medications. Do you have pain management providers that are willing to consult with the provider managing the pain pump to refill? What is the best approach for this particular patient population.

Thank you
Marilyn

Hello,
I am curious as to what others are doing with the ISMP IV push guidelines and to not dilute medications unless required. For CVC/PICC lines in particular what is your practice with such medications as IV dilaudid (which does not require dilution)to be administered in these vascular lines? Concerned with the recommended 10cc syringe to reduce excessive PSI pressure in line and the very small amounts of dilaudid ordered at times.
Thank you in advance for your input.

Marilyn Hargett

Hello,

Back in May, the CDC released an interim statement about the possibility of neural tube defects in infants exposed to dolutegravir in utero. Here's the document: https://www.cdc.gov/hiv/pdf/basics/cdc-hiv-dolutegravir-alert.pdf

Since PEP is such a short course of therapy, the question is whether dolutegravir should be used in patients where pregnancy is only suspected (e.g. sexual assault victims, unprotected sex with someone whose HIV status is questionable, etc.)