For those institutions following the requirement to filter fat emulsion infusions with a 1.2 micron filter, have your nurses reported issues with the filters, especially after pausing the infusion to administer intermittent medications? Our nurses are getting downstream occlusion alarms on the pumps once the fat emulsion is started again. If you've experienced this, any suggestions on how to prevent this?

Thanks!

Our institution seems to have had a recent uptick in life-threatening adverse reactions to protamine administration in the past couple of months (hypotension, pulmonary vasoconstriction, cardiovascular collapse). We have reported 4 cases to FDA MedWatch, but are interested if this increase has been noted at other institutions. We have not identified anything preventable upon review of the cases. Have any of you noticed this at your facilities?

We have recently switched to monitoring heparin assays for our weight based heparin drips and have had several situations where the heparin assays have remained subtherapeutic despite high doses of heparin (>25units/kg/hr). This has been occurring more in our critical care population. Has anyone encountered the same issue and have any guidance on how to manage ( argatroban vs giving thrombin vs alternative monitoring vs other) thanks.

Does your facility allow insulin to be pushed on med surg units besides hyperkalemia and under what conditions? thanks

We are an Allscripts (Sunrise) institution and are instituting BCMA for our pediatric services.

For medications ordered PRN or a one time dose that are pulled by the RN from the ADC and not dispensed by pharmacy, how do you have this set up to scan?

Currently the provider uses the regular order for a one time dose however, when the RN scans the vial removed from the ADC we get a mis-match warning and therefore no warning that only part of the vial has to be given.

We are a pediatric hospital and frequently use empty, sterile IV bags. With the national shortage we are implementing processes to conserve our supply. We have: 1) split IV doses up to 240ml into equal volume syringes 2) Compound selected drips in pre-made IV fluid bags 3) Compound stock bags of medication in larger volumes 4) Communicated with providers for IV to PO conversion and timely discontinuing of IV fluids 5) Antibiotic Stewardship will help ensure antibiotics are ordered with the longest acceptable frequency.

I would like to network with organizations that have a low number of heparin events and/or have completed work to improve safety surrounding heparin. Our hospital is doing a comprehensive review of our heparin processes. Please contact me if you would be willing to speak concerning heparin. Thank you for your consideration.

Our organization is trying a therapeutic interchange to Levemir. We have some exception criteria to allow patients to stay on Lantus, which we are guessing will be about 30% of patients.

Currently we stock Lantus as a MDV in our ADC and send up Levemir as a patient specific medication. With the change, we are considering stocking both Levemir and Lantus as MDV in the ADC.

Do any other organizations allow this and what safety measures have you been able to implement to prevent confusion with the two brands.

Hello,
I am a Canadian pharmacist so forgive my ignorance of Joint Commission requirements.
I understand JC has requirements for policies/education around standard interpretation of orders such as HYDROmorphone 0.5-1 mg subcut q3h prn.
Would anyone be willing to share policies/educational tools or other approaches to ensure that such orders are consistently interpreted in your organization.

I am looking for some guidance on when it is ok to use a midline instead of a picc line for certain antibiotics. I have researched this topic to death and still come up with conflicting answers. I know that if the pH is <5 or >9 or >600 mOsm/L the drug should be given via picc line but some drugs in the grey area like Ampicillin (pH 8-10) or Meropenem which seems to fall in these guidelines (pH=7.3-8.3 300mOsm/L)are still listed on most "central line only" reference charts.