I wanted to ask how organizations are handling orders for SGLT2 Inhibitors for inpatient use in light of the drug safety communication from May 2015 regarding the risk of ketoacidosis that can present atypically. The agents are non-formulary at our institution. However, should an MD order an SGLT2 inhibitor, we are encouraging pharmacists to have a discussion with prescribers about alternatives and use clinical discretion. This includes discontinuing the mediation if a patient presents with DKA symptoms.

Hello,
I would like to get some feedback for the group.

Do any institutions have issues of not being able to fit all their medications in their automated dispensing cabinets on the floors? If so how do you handle this specifically looking at controlled substances.

Do you always keep the controlled substances in the ADT? Do any institutions utilize "narcotic boxes" or other locked cabinet on the floors or do you always keep your controlled substances in the ADT and allow non controlled substances to overflow into another cabinet?

We have been a no insulin pen health system for quite some time. We are receiving many requests for the use of Toujeo, which only comes in a pen. Has anyone, who is historically a non-insulin pen hospital/system, allowed use of this product? If so, what safety precautions have you put in place? Also if not, how have you prevented errors with conversions of doses? Thanks in advance!

For purposes of eMARS, does your organization use sliding scale insulin as PRN or SCH? Has ISMP weighed in on this issue? If you use scheduled, have you seen any medication errors involving patient receiving unwarranted SSI?

THanks for your help,
Emily Spiceland

Does anyone have discharge criteria from ED after administration of opioid ?

In our health system, our adult hospitals have nursing associates program PCA pumps. Our pediatric hospital has Pharmacy program PCA pumps. We would like to standardize this process and have some disagreement around this. Who programs your PCA pumps? Pharmacy is the drug expert, but Nursing is much more familiar with the PCA pump. If you have pharmacy program them, what is your rationale for that? Thanks,

Cortney Swiggart

We are in the information gathering process regarding creating more of a formalized Medication Safety Officer role and we had a few questions.

1.) FTE allotment
2.) # of beds at institution
3.) Credentials/certification/training
4.) Job role - daily activities, committee involvement, etc...

Thank you!
Sarah Gallup, PharmD, BCPS

We are about to begin our journey with Smart Pump Implementation and would like information from those of you who have completed this journey.

1) Who built/owns the drug libraries?
2) How often are your libraries updated?
3) Did you require additional FTE's for implementation or maintenance of drug libraries?
4) Who reviews data/reports from pumps and what is done with that information?
5) Are your pumps Integrated with your EMR? What issues have you had related to having or not having this?
6) Any other tips?

Hoping to learn how other organizations have built naming conventions for epidural products in their CPOE, pharmacy labeling and smart pump systems.

Do you list the narcotic component first and anesthetic component second OR the anesthetic component first and narcotic component second? (i.e. HYDROmorphone-bupivacaine or bupivicaine-HYDROmorphone)

Is this naming convention standard across all systems--CPOE, pharmacy labels and smart pumps all list same way, or are there differences?

Thanks for any info you can share!

Don

Would anyone be able to share how IV insulin doses are prepared and administered in your OR and PACU areas? Usual doses would be 10-20 units IV x1.
How do the nurses draw up the doses? Do they use insulin syringes or TB 1mL syringes?
Is the dose transferred into another syringe, where the nurse further dilutes the dose prior to administration?
Thank you for your inputs!
susan