Has anyone adopted: 1 to 6ml of Hyaluronidase for each 1ml of extravasated drug into practice (Paclitaxel and Vinca Alkaloids), per "Management of Drug Extravasations" (Lexi-Drugs)?

Would you be willing to share the dosing your institution utilizes or policy?

We are not sure when it changed but prior to this it was, "Hyalurondidase 1 mL (15 units/mL) as five separate 0.2 mL injections (using a tuberculin syringe) around the site of extravasation". May have changed around December 2023?

We are seeing an increase in ferric gluconate infusion reactions, resulting in some ED visits. I saw there was some discussion on this earlier. I wanted to see how everyone is administering and storing the ferrlecit. We use Hikma product and their manufacturer does not have refrigeration stability but based on Trissels and a published study on a different generic, we store in refrigeration for 7 days. We also have 250mg diluted in 250 mL and administered over one hour. Interestingly, we don't see the same anaphylaxis reactions in our inpatient doses, which are made on demand.

Our institution has previously required a chest x-ray to confirm the line isnt misplaced before administering alteplace for clearance . Our team is considering removing this requirement for a chest x-ray.

Do your institutions require a CXR prior to alteplase administration?

My primary literature search resulted with one finding
https://pubmed.ncbi.nlm.nih.gov/27957798/

Thank you!
Emily Schwabe

Hey all,

As part of our discharge counseling, our pharmacists are doing teaching on enoxaparin injections. We have the "artificial skin" pad to practice injections, but was wondering if anyone knows of a demo syringe. Something similar to the training device that comes with Epi Pens...but for Lovenox.

If there is none available, what are your sites doing for teaching?

Thanks!

We have had two recent cases of prefilled enoxaparin 40mg syringes malfunctioning when the safety shield was trying to be activated by the RN. In both cases the needle and plunger shot out of the syringe like a dart. We carry Fresenius Kabi enoxaparin syringes, and it was the same lots number involved in both cases. We have reported to FDA Med Watch and ISMP but wondering if anyone else has experienced something similar recently? Thanks.

We have had a handful of medication errors associated with very low body weight adults (<40kg). We currently use Epic as our EHR and FDB as our drug/data vendor and there are no dose/weight warnings for our adult patients on most medications. I don't want to create an alert for every time a medication is ordered as that would cause alert fatigue. Has anyone encountered this issue and figured out a potential solution?
Thanks!
Lindsey

Hi All
We want to switch our current heparin infusion protocol over to the Epic heparin infusion calculator. We currently have a lot of different protocols and I was hoping to gather other hospitals order sets/examples of their protocols to use as a starting off point. If you have/are using Epic and the heparin calculator protocol please share your order sets and any other tips appreciated!

Thank you!
Lindsey

Hello, we are performing our annual review of the medication override list and I am hoping to get input from the team regarding what resources the institution utilizes to establish their override med list.

We currently do not specify the concentrations available for override and I wanted to get a perspective on safety associated with that.

Thank you!

Good morning!

Historically we have done a 25mg in 50ml NS of Iron Dextran infusion over 15 mins. What is the BUD that other sites are giving this?

Thank you!

Hi everyone,
Hoping someone can clarify language in the VA's Safety Assessment Code matrix.
https://www.patientsafety.va.gov/professionals/publications/matrix.asp

Major includes the criteria "Increased length of stay for three or more patients" and "Increased level of care for three or more patients."
Minor includes "Increased length of stay or increased level of care for one or two patients."