Our Pediatric Hematology Oncology Physician has noticed a toxicity pattern with our leukemia patients receiving high dose methotrexate. It seems that the patients have had delayed clearance and more severe myelosuppression than usual. She feels that it could be related to the product we purchase. We currently purchase methotrexate manufactured from Accord/Hospira and Teva. The manufacturers haven't had any recalls to date. I was wondering if anyone in our MSOS group, who purchases methotrexate from these manufacturers, have noticed the same patterns.

Thank you for your help.

Hello everyone,
As has been discussed previously, there has been a recent change to the filtering requirements for IVLE products like Intralipid (use of a 1.2 micron filter when administering). I received a question about filtering propofol, and wanted to ask if anyone has changed their practices for filtering propofol because of this recent recommendation. After a scan of product monographs (Canadian), it seems that it is still advised to not use a microbiological filter for propofol. However, I am wondering if anyone on this forum has any thoughts on this topic.
Thanks!

Hello,

I was wondering if it would be possible to find out what everyone's practice was regarding giving the bolus dose of magnesium in Obstetrics (for preeclampsia,etc. Particularly if you use Alaris pumps. Do you bolus from the 20g/500 ml main infusion bag? Or do you send separate 2,4 or 6g bolus bags and then start the main infusion? Also do you have pump integration?

Hello,
One of the administration type errors that continues to pop up for us, is the process where drug A is run at the rate intended for drug B ( and vice versa). Has anyone done any work around this or do you have a process in place that you're willing to share which results in a low error rate for this type of error.

Thanks.
DiAnthia

Hi, we are currently needing to expand our Time-critical med list following a recent DNV survey. Would you be able to share what meds you have on your list for Time-critical meds to monitor?
Thank you!
Susan

Good Morning,

Curious as to how everyone manages allergens and controls at their institution? Everywhere I've worked they seem to be handled a little different. Should these be considered drugs and subsequently ordered, inventoried, dispensed from pharmacy or do you not consider them drugs and the allergy department manages it themselves. To be specific, we are not talking penicillin skin testing. I'm inquiring about aeroallergens (dust mite mix), animal epithelia, fungi, tree pollen etc in small 5 ml vials.

Thanks,
Dachelle

Hello,
I am interested to hear how other institutions have handle the potential confusion when a patient is ordered both medications (epi & norepi) as IV infusions. They have the potential to read the label incorrectly since they are SALA meds.
What strategies do you have in place to assist the nurse?

Thank you
Marilyn Hargett

Can you tell me what you use for an automatic stop for short-acting opioids. We are using 72 hours but would like to extend to a longer time frame to avoid orders not be reordered when needed and dose omissions/ patient harm.

Thank you,
Ann Jankiewicz, PharmD, BCPS, FASHP
Rush University Medical Center

I wanted to see if anyone is stocking and using syringes that are smaller than 1 mL volume- specifically 1/2 mL. If so, was this decision made to help with accuracy and/or volume errors with a total volume ( TV) less than 1 mL. This question is not geared to the use of TB syringes.

Thanks.
DPatrick

Limiting the number of available drug concentrations is a standard strategy to decrease the potential for error. I am interested in those institutions that do not stock heparin in either the 10,000 and 20,000 unit/mL concentrations. If you have eliminated these high concentrations, what were the barriers you had to overcome? Examples: higher concentrations are need for dialysis machines or needed for SQ prophylactic doses of heparin in bariatric patients.