Our institution is considering moving to Myxredlin insulin bags from Baxter, but it was recently discovered that the product contains a phosphate buffer. Lexi-comp shows compatibility w/ calcium at the y-site, but when checking with Baxter to confirm, it sounds like they haven't conducted any studies on compatibility of Myxredlin with IV solutions - so no data to support. Wondering if any other institutions that use this product were aware, and if so, how have you handled this. Thanks for your consideration!

We recently transition from auto-verification to pharmacist verification in our periop areas. We are now having some issues with prn pain duplications. (i.e. pt was on oxycodone prn for severe pain while on the floor and then once in pacu, an order for dilaudid prn severe pain is ordered). Since these are 2 different phases of care, would having both of these ordered be allowed by TJC? If not, does anyone have any suggestions on how to navigate this scenario? Thanks in advance!

Good day all,

Curious if anyone is allowing duloxetine capsules to be opened for feeding tube administration, etc?

The generic products (not Drizalma which has been discontinued) appear to have been reformulated to have smaller sprinkles within the capsules that a small enough to pass through a feeding tube. In addition, there appears to be a study supporting stability and this practice. https://www.sciencedirect.com/science/article/abs/pii/S0149291808800549?...

When scanning the square 2D Matrix barcode on vaccines, we have found the lot number field in EPIC is populated with the lot number...plus a long string of extra digits. If those extra digits are not manually removed, it creates inventory discrepancies with our state-supplied vaccines (which look for an exact match for lot number).

For background: We are scanning the outer box 2D matrix barcode, and documenting administration using the EPIC immunization activity.

Our ICU has started using cycled dexmedetomidine drips to promote a more normal sleep/wake cycle to prevent/treat ICU psychosis. The providers want to include naps as part of the workflows in our patients 2 years of age and younger. We are exploring order options within Epic to prompt the RN to change the doses and allow for usual barcode scanning. Does anyone have a process that works well at your organization?

Hi all,

We recently have had a spattering of reports that the spike is falling out of Fresenius Kabi heparin 25000 unit/250 mL bags. This has occurred in patient repositioning and just during transport. I was able to easily replicate this in my office.

Has anyone else experienced this issue, or have any mitigation strategies?

Thank you,

Kara Thornton

Does your organization have a policy or protocol related to management of diabetes while patients are observed in the ED? Thinking specifically of how we can mitigate risk of patients with type 1 diabetes going without basal insulin for too long if they happen to be held in the ED for a prolonged time. What about policy/protocol for checking blood glucoses at regular intervals when they have not yet been admitted?

Appreciate any insight you may have.

Sloane Hoefer, PharmD, BCPS
Nebraska Medicine

Good morning,
With the updates to ISMP best practices and high alert lists related to tranexamic acid, we are re-evaluating our dispensing practices for this medication. I have a few questions for the group:
1. How are you dispensing TXA for nebulization?
2. How are you dispensing TXA for topical use?
3. If you have any order panels or order sets that work well or safety measures you have implemented for this medications that you are willing to share, I would greatly appreciate it.

Thank you!
Jordan Anderson
Driscoll Children's Hospital

Hello,

For those involved in USP 800 program implementation/maintenance for your organization, especially larger institutions with a main cancer center and many community infusion centers:

What is your general approach to handling hazardous drug spills?

1. Do you have different processes for large centers vs. small community sites?

2. Who is involved in the hazardous drug spill response? What (if any) role do the following stakeholders play: pharmacy, nursing, chemical safety, environmental services, etc.?

We are working on updating our policy on 503B outsourcing to standardize our process. Does anyone have a policy they are willing to share? Our current policy is so vague I'd like to add a SOP to delineate the specifics. My biggest concern is the documentation piece. Do you require quarterly safety reports?