We have had some recent errors with non-formulary medications. Wondered what others are doing with these meds. Has anyone considered adding them the their "high risk medication list" or have any creative ideas for managing them.

Does anyone currently use an oral dosing cup with only mL markings?
If so, please let us know the manufacturer.
Thanks
Sue

I just finished attending the USP 800 presentation at the ASHP Summer mtg. It was a great review of chemo handling, but I wanted to hear more about handling non-antineoplastic hazardous drugs. Guidelines for handling chemo are pretty straightforward and staff are on board. It's the non-chemo (spironolactone, carbamazepine, oxytocin) that is causing confusion and frustration. The speakers said to do an "Assessment of Risk", then you can handle non-chemo differently...I am not a toxicologist and do not feel that I have the expertise (or liability insurance!) to make that kind of call.

Hello,

Our maternal-fetal medicine group occasionally does intrauterine procedures including PUBS and intrauterine fetal transfusion. To facilitate cannulating the umbilical cord (obviously a high risk procedure) they require vecuronium to paralyze the fetus. We are trying to standardize how we dispense vecuronium for these procedures since these cases are so high risk and cause so much anxiety for both the pharmacists and physicians.

Do any other institutions perform these procedures? If so would you be willing to share your dispense process?

We have had some errors with non-Formulary medications. Has anyone classified these agents as high risk? We scan the non-Formulary meds when dispensed but they are not scanned when administered. Staff can be unfamiliar with them and can be error prone. How have other places addressed non-Formulary meds from a safety perspective?

The Malignant Hyperthermia Assoc. of the US (MHAUS) recommends stocking 100 mL sterile water for injection vials (without a bacteriostatic agent) to reconstitute dantrolene. These vials are not available from our suppliers (all have a bacteriostatic agent in them)and the Nurse Educators state that it would take too long to reconstitute each vial individually and therefore use a bag of sterile water for injection and use a "transfer infusion set" that utilizes one bag for multiple dilutions, thereby saving time.

Are RhIG products stocked in the pharmacy at your facility?

If yes, what safety strategies do you have in place for these items?

Do any of you have an observation based error tracking system in place?

What system do you use?

What types/how many process improvement projects or action items have been identified using observation based error tracking?

How has your organization responded to this type of tracking? (positive vs negative feedback)

How long did it take to implement?

Any insight is greatly appreciated!

Thank you,

Are any facilities using KCL for therapeutic abortion in the OB clinic setting? If so, how have you structured the ordering and dispensing workflow? What safety checks do you have in place.

Best,
Drew

According to The Joint Commission's standard MM.03.01.01, EP 10 "Medications in patient care areas are available in the most ready-to-administer forms commercially available or, if feasible, in unit doses that have been repackaged by the pharmacy or a licensed repackager."

Lorazepam is available in a Carpuject, but requires special equipment, training, and extra storage space.