We currently stagger the administration of our ACE-Inhibitors from other blood pressure medications given a 0900 (the ACE-I’s are given at a unique time of 1100). We have recently received feedback from Nurses that they are dissatisfied with this process because it requires an additional pass of meds. I’ve been asked to assess if other institutions have an established practice to stagger blood pressure meds.

What is the practice at your hospital?

Does anyone have a guide they would be willing to share regarding what their policy is when a medication dose is late/missed and how subsequent doses are re-timed/adjusted?

Are there any national standards or does each institution develop their own policies?

Thank you,

Randi

We are having problems with titration orders not being followed because of nurse using clinical judgement. For example titration order is to titrate by 5 mcg/min every 5 minutes but based on patient's condition, nurse titrates by 3 mcg/min or titrates at 3 minutes instead of waiting until 5 minutes. TJC nearly cited us for this at our last visit. Is anyone else having this problem and if so, what are some potential solutions?!! Thank you,

Greetings,

We'd like to get a sense of when you are requiring a second pharmacist to double-check a medication in a child, when a first pharmacist has already verified it. Specifically:

Do you have a specific age where a double-check is no longer needed? If so, what age?

Do you have a specific weight where a double-check is no longer needed? If so, what weight?

Do you limit your double-check to particular medications? (Or exclude particular medications?

Thank you,
Dan Sheridan
OhioHealth Marion General Hospital

Hello,

We are trying to implement patient specific lantus/levemir at our peds hospital and peds units. The adult hospitals have already implemented this best practice. We are experiencing a barrier in our endocrinologists and nurses.

They prefer to get the full vial for teaching purposes at the bedside. Has anyone else experienced a similar situation? How were you able to convince the providers to make the switch?

Thanks!

Hello,

We are building an orderset for insulin R U500. We have followed ISMP guidance and will be dispensing these doses patient specific in a TB syringe. However, we cannot find guidance regarding naming of the product in EMRs.

Can anyone share what they have used as the name in their EMR?

We are considering "Insulin R 500 units/mL" or "Insulin R (U500) 500 units/mL" or "Insulin R (concentrate) 500units/mL".

Any and all insight is most welcome! Thanks!

Hello,

We have a new doc ( neuro-opthalmologist) who wants to start using this but we can't find any "recipes with references".
Does anyone have one they're willing to share?

Is anyone compounding this from cocaine power or flakes?? If so are you treating this as "high risk" therefore needing end product testing?

Thanks.
DiAnthia

Hello,

Our OR team would like to start using clevidipine instead of nitroprusside. Since clevidipine has a milky appearance like propofol, there is a safety concern. Any of you use clevidipine in the OR setting? Any safety mechanisms you have in place? Any information you can provide me would be greatly appreciated!

Thanks,
Haesuk Heagney
Mayo Clinic Florida

We have been waiting for over 1 year to implement a new system of central monitoring. All of the tags/sensors and probes have been in place for the last year, but we were waiting to swap out many of our med refrig bc the old ones went out of range all the time. We have over 150 med refrigerators. For those who use a central monitoring system:

Our practice has been to date all bulk bottles ( liquids) with date opened but are considering discontinuing this practice. In speaking with several manuf, product is good until expiration listed unless otherwise specified.I have not found any regulations mandating this practice. Since some bottles are low use ( and expensive $500) we do not want to discard after a year which seems to be what we have done in the past. Any thoughts?