Do any facilities require an independent double check for all oral chemo EXCEPT for hormonal antineoplastics (e.g. Megace, tamoxifen)? If so, what was your evidence/rationale? We are considering excluding hormonal antineoplastics from our IDC requirement. Our EHR is currently programmed to require a dual sign on ALL meds with an AHFS therapeutic class of "antineoplastic". I'd like to have evidence that giving too much of a hormonal antineoplastic will not harm the patient like other oral chemotherapies could...

We had a potential issue with a patient who had an aminoglycoside allergy entered and then had a reaction to flu vaccine when administered as an outpatient. At the time we were unaware that aminoglycosides are used in the manufacturing process for flu vaccine because our system database does not alert for that. We are trying to create a workaround for this alert and it seems to be taking more time than necessary

Has anybody had to deal with anything similar?

What alteplase concentration(s) does your institution use for catheter-directed thrombolysis procedures (e.g. 0.02 mg/mL, 10 mg/500 mL)?

If you’re using multiple concentrations, what safety measures have you put in place to minimize concentration mix-ups, specifically order entry errors and smart pump entry errors?

I will compile the results and attach to this discussion thread.

Thank you for your help!

Rosemary

I am trying to research the following query for our Patient Safety Physician Champion:

"Can Cerner automatically count morphine equivalents of narcotic medication administered over a specified time period and alert providers, Pharmacy, and nursing when trying to order/administer additional narcotic medication over a specified threshold?"

Scenario might be something like a patient receiving multiple Morphine IVP x1 doses for severe pain in the ED, then floor MD continues to order multiple Dilaudid IVP x1 and then bottoms out. Could even be on the same floor.....

How does your facility store/dispense flammable medications such as benzocaine aerosol?

Is anyone using multidose insulin vials, kept in medication rooms and not brought to the patient bedside, to be used on more than one patient, provided the nurse is following proper infection control practices when drawing up the dose in the medication room? If so, I would like to hear from you what the nursing workload is like in regards to bar code scanning of the medication and if you employ any independent double checks as well. Thanks!

The P&T committee has requested a policy and procedure be developed regarding ambulatory pumps and use of these pumps while inpatient. Our first priority is insulin and then we shall be expanding the policy to include other ambulatory pumps. Does anyone have a policy and procedure they are willing to share?

Thank you!
Laura Herbrechtsmeier, RPh

laura.herbrechtsmeier@wfhc.org

Hi All,
We are wondering how everyone is handling the administration of ampho B bladder irrigation. Unlike other bladder irrigations, it is infused at a prescribed rate (42 mL/hr). Nursing has been using IV pumps to control the rate. Unfortunately, there is no irrigation tubing available compatible with the IV pump so the nurses have created a workaround by using modified IV tubings for this purpose. We are obviously not comfortable with this so we wonder how everyone else is handling this.
1. Is ampho B bladder irrigation still used in your facility?

Greetings,

We have been having issues with our lab and nursing coordinating the appropriate time to draw medication levels (mainly vancomycin). On most occasions, the medication is infusing while the the lab is being drawn. All lab and medication orders are timed appropriately. Our hospital uses Cerner for our healthcare information system. I would like to have the ability to place a level reminder on the MAR to alert the nurse that a level has been ordered. I was wondering if any hospital has had this similar issue and how it was fixed.

Thanks,

Jim Galasso

Good Morning,

We are considering changing our practice on the way we dispense warfarin. We currently dispense it patient specific as part of our protocol for patient safety goal 3E. We are now considering loading it into our pyxis. Wondering how others are doing this and if any concerns/issues have come to light if your facility uses pyxis for dispensing.

Thank you,
Kelly Estremera, RPh, BCPS
Bangor, ME