In your organizations, could you please describe your approach to ensuring that appropriate patient monitoring takes place to support the safe use of a medication at the point of medication administration (i.e. at baseline, during admin, following admin)? This could include monitoring related to an IV drug known to have hypersensitivity reactions at the time of infusion OR could include monitoring following an oral antihypertensive.

Protamine has a black box warning that describes serious reactions (including cardiovascular collapse) to certain patients especially those known to be of higher risk (such as use of protamine-containing drugs including NPH insulin, allergy to fish, previous vasectomy, etc.).
• In light of this warning, do you have a protocol in place to note if the patient is at a higher risk for a reaction before procedures?
• Are you giving test doses of 5 mg to patients? If so, has this helped to prevent serious reactions?

For those that use the Alaris syringe pumps....Do you keep the near end of infusion alarm on or off? Our nurses want to have them turned off and we want to see what other institutions are doing.

Thanks,

Randi

Randi Trope
Pediatric Medication Safety Officer
Cohen Children's Medical Center

How do you store multiple use meds for patients on contact isolation (i.e. inhalers, creams, eye drops, etc)? Do you keep them in the patients room or return them to Pyxis? If you keep them in the patient room where do you store them in the room?

Thanks,

Randi

Hello,

Our hospital is considering moving to the Aerogen system for continuous nebulized medications (epoprostenol and albuterol) because it offers a non-luer compatible syringe and tubing set as well as a blue colored plunger and tubing to hopefully prevent wrong route errors. We also plan to use a different brand of syringe pump than we use for IV medications per ISMP recommendations.

Do you dispense cyclosporine PO solution in syringes? If so do you have a reference that states stability? Specifically looking for Gengraf brand.

Hello,

I am collecting information about the different ways that pharmacies dispense BCG.

How does your pharmacy prepare and dispense BCG?

ie. How many preparations of BCG do you do per week? Who prepares the product? What type of hood, if any do you use? What kind of handling precautions do you have in place? How do you operationalize this?

Thanks!

Bridget Gegorski
Bridget.Gegorski@uhhospitals.org

Dear all,

I am wondering if anyone has a specific policy in place at their institution which addresses opening dofetilide (Tikosyn) capsules for oral administration. It seems to be a bit of a gray area. ISMP has not addressed this to date and the manufacturer offers no clear guidance.

Thanks in advance for your response!
Ted

As the practice of medication safety is blossoming, there are more and more of us practicing (including myself) with less experience in regulatory and process improvement skill sets.

We are all aware of this forum (obviously), the ASHP forums, the ISMP, and the Med Safety Collaborative.

What other resources/ books/ guides/ programs have you used, or are using, to improve your practice and knowledge base?

With the new Clozapine REMs we are looking at how we remind the pharmacists and document inpatient pharmacist checking the REMs website in our EMR. We are using EPIC. Please share with me what systems you have in place in your EMR/EPIC for clozapine.

Thanks!

Susan Shermock, PharmD
Medication Safety Manager
Howard County General Hospital
Columbia, MD