As we all continue to navigate the large volume IV fluid shortage, how are organizations handling heavier use areas such as in urology (aside from considering delays in elective procedures)?

Has anyone explored sterile compounding?

It sounds like we will need to move to compounding 3% saline due to the fluid shortage.

We can make it 2 ways – base as SWFI and base as NS.

SWIF base: 64.1 mL 23.4% NA and 435 mL of SWFI
0.9% NS base: 46.7 mL 23.4% NA and 453 mL 0.9 ml NS

SWFI has the (+) of not have saline on the bag so someone does not mistake it for a 0.9% with some other additive but requires more 23.4% saline which goes in and out of shortage. Can someone share if there is a ‘safer’ way to compound 3% saline? and labeling? Thank you!

Hello everyone!

Do you all have policies that explicitly say to give heparin drip via a dedicated line?
And is it run as a primary line vs secondary?

None of our policies specifically say this and we're getting push back from a few folks that want the ability to use the same line for other meds. My understanding has always been that it should be through a dedicated line due to multiple reasons:

For facilities that utilize common vial insulin in ADCs for subcutaneous insulin, what is the process for the nurses drawing up the insulin? Are they using an insulin syringe at the ADC and recapping with the original cap or do you have a different process? Thanks!

With fluid shortage we are toggling between Normosol (mfg ICU medical) and PlasmaLyte (mfg Baxter). Products have nearly identical composition. There appears to be a difference in data surrounding use a fluid warmer. Baxter is able to supply data for their PlasmaLyte product, however no such data seems to exist for Normosol. Plasmalyte is frequently placed in the warmer here, so this poses potential confusion and issues if Normosol is used as a substitute.

I am curious if others are encountering issue above and if there are any strategies that have worked well?

SPS powder comes in both 15g and 454g bottles and dosing is typically in intervals of 15g and can be given multiple times per day. Directions on manufacturer bottle is to dose in g or use "level" teaspoons.

My question is coming from the outpatient dispensing perspective, but appreciate inpatient dispensing perspectives as well.

Questions: Do your pharmacies dispense an administration device for sodium polystyrene sulfate (SPS) powder or are patients to rely on home teaspoons?

What are the default SIGs in your CPOE for SPS powder (g or teaspoons)?

For those of you who use Epic, what type of access do you have? Specifically, your "job" role. Currently, I have access to Inpatient Nurse, Inpatient pharmacist, and inpatient quality. I do not see the view that out-patient clinics have, or even our hospital based interventional areas. When investigating errors that occur in those areas, I usually have to go to that department (or via Teams) and have a user log in so that I can see what they see. This has been problematic for may reasons. Does anyone have any suggestions?

The following drugs are needed for post partum hemorrhage: oxytocin vial, methylergonovine vial, carboprost vial, tranexamic acid 1 gram infusion bag, and misoprostol 200 mcg tabs x 4. The Birthing Center wants them in a kit (not an Omnicell virtual kit). The challenge is that methylergonovine and carboprost are typically stored under refrigeration. Does your organization have a physical kit and how is it stored?

Dear Med Safety Board,

As part of our effort to standardize practices across our pharmacy departments, we are implementing the use of leur slip syringes for dispensing all SQ/IM doses, including those for pediatric patients. Under this new process, pharmacy will dispense medications without needles attached, and nursing will add the appropriate needles at the bedside.

Hi-
ISMP's guidance on IV push med safety prompted us to examine how we are giving IV push opioids. We determined that a fair amount of nurses are using carpujects as vials and are not using carpuject holders. Can anyone share their best practice recommendations on using carpuject holders? Are they used on multiple patients? How are they cleaned in between use? Where are they stored?

Thank you in advance.

Sara