Hello,
Would anyone be willing to share their policy/procedure on high alert medications and your high alert list? We are looking to update ours.
Thanks,
Rachel

Would you please share your institutions practice for STAT SL nifedipine doses for pediatric patients? Does the dose come from the pharmacy or are doses available in the Automated Medication Cabinet? Thank you.

For those institutions that utilize automated dispensing cabinets, can you provide information regarding your error prevention strategies at the machines?

A recent mock surveyor noted that red and yellow bins should be used to differentiate/segregate high alert and look-alike/sound-alike drugs within the ADCs. We are using colored bins to differentiate these products within the pharmacy, but have not operationalized this outside the department. We want to ensure any process we put in place will be sustainable.

Hello! We are looking at revamping our fosphenytoin dosing guidelines/restrictions.
We currently have restrictions based on patient location and monitoring capabilities. For example, we do not allow loading doses to be given on a general floor due to the lack of bedside telemetry monitoring. We do allow maintenance dosing on a general floor.

We have standardized to insulin lispro for our glycemic control insulin protocols, but we still have Regular insulin product on floor stock for those instances when it is needed for hyperkalemia.
If those hospitals that have been successful in removing Regular insulin from floor stock, how do you manage hyperkalemia situations?
thank you!
Susan

How do you have staff dispose of partial vials of propofol? Does Surgery dispose it differently?

We are looking at implementing a guideline regarding ketamine infusions for acute pain crisis (palliative care) as well as post-operatively in reducing narcotic use in chronic opioid patients.

We are still debating the nursing piece and level of monitoring required.

For those of you that use ketamine infusions for these indications:

1. Is ketamine restricted to a particular floor (eg: telemetry)?
2. Can these infusions be adminstered on a med-surg floor?
3. How often are vitals needed?
4. Are nurses able to titrate the doses?

1) Does your institution allow for hydroxyzine to be given IV?
2) If you can give IV is it limited to certain patient populations only?
3) If you can give IV what safeguards do you have surrounding it's IV administration to avoid extravasation?

Thanks,

Randi

ISMP is beginning the process of developing the new 2018-2019 Targeted Medication Safety Best Practices for Hospitals. We would like ideas from you for either issues that need a best practice, or the best practice itself. Remember the criteria is that these are issues that have cause serious harm or death over many years, and can be addressed by one or two best practices in most cases. Please respond to this posting, or send me an email at drich@ismp.org. Thanks for your input.

Hello all,

Could anyone share their inpatient policy or guidelines outlining sodium content (min and max mEq/L) allowed in maintenance IVF? We would like to establish guidelines for pharmacist clarification on the general care units/ intensive care areas.

Thanks,

Jenn Bonvechio
Akron Children's Hospital