Good morning,

Does anyone have a process for preparing this product and what precautions you have taken? Have you or would you allow this to prepared bedside? It has a short stability of 1 hour per the manufacturer. They do provide instructions for preparing the product (from their fact sheet for HCPs):

We recently started looking at how and where our pediatric/NICU IV medications are being prepared, in the pharmacy or on the floor by nurses. Many of our IV push medications for NICU are prepared and diluted by the nurses on the floor with a 2 nurse check before administration. ISMP and Joint Commission both recommend supplying medications in the most ready to use form which would mean preparing these medications in pharmacy. Our NICU and pediatric departments are not large so this does not come up often.

Hi all,

We recently implemented a pharmacy to dose TPN protocol and are now re-evaluating potential potassium limits. Does anyone have a suggested or hard limit max for either total potassium contents per TPN or a mEq/L limit for TPNs at your institution?

Thank you!
Sheena Burwell, PharmD, BCPS, CTTS
Medication Safety Specialist
WVU Medicine - WVU Hospitals

I was wondering if there is a clear medication safety rationale on how specific dosage forms make their way onto the High Alert Medication list, requiring a double check by two registered nurses (RNs) during administration in the Epic system. IV morphine requires a double check by two RNs, but PO morphine doesn't.

Hello colleagues,

Our Epic institution utilizes an active interval setting of ZERO hours when it runs interactions for currently placed orders. Therefore, it does NOT capture completed ONE TIME orders for duplicate therapies, which may pose a safety concern given particular medications. Can anyone speak to their Epic configuration of this setting? I am wondering if this setting should be adjusted to capture doses within the past 24 (or less) hours to prompt a closer review, or if this would result in nuisance alerts.

Your insight is much appreciated,

We have been compounding L.E.T. solution in small cups and have had a request to switch to L.E.T. gel. In searching 503B compounding companies, we are only finding this stored in oral syringes. We are uncomfortable dispensing a topical product in an oral syringe but are hoping to outsource this. What are other adult or pediatric hospitals doing?

Hi all!
My institution does weight-based heparin infusions with aPTT guided dose adjustments done by nursing according to detailed titration instructions.
We often see medication errors in which the nurse enters the dose into the incorrect field. All doses should be entered in "unit/kg/hr," but the RN often mistakenly enters the dose in the "mL/hr" field in Alaris -- of course this ends up in the patient receiving the wrong dose.

Hello all,

We are working on a justification to grow our Medication Safety Team. We are being asked to collect information regarding number of Medication Safety Team members at other institutions.

How many team members are on your medication safety team?
How large is your hospital/system?
What is the makeup of your medication safety team (technicians, leadership roles, etc)?
If you are willing to share number of medication related safety events, please do!

Hello! We dispense a standard bag size for all adult patients on tacrolimus IV (2.5 mg/250 mL). It is built as a continuous infusion to allow for dose adjustments as soon as the level comes back in the morning. We also have this med on our Time Critical List and a standard administration time of 1800 (new bag is hung at 1800 regardless of how much is left in the bag). We are running into issues since the continuous infusion build in Epic does not put due times on the MAR and the med occasionally is being administered late.

Our facility infrequently uses PPN for patients with post-op ileus who may require just 1-2 weeks of parenteral nutrition and otherwise don't have or need central access. Due to osmolarity we require lipids run simultaneously with the dextrose/amino acids compomnent of the PPN. We have had events where the lipids were not run concurrently. This has led to discussion of a 3-in-1 PPN formulation. Our TPN (central parenteral nutrition) would remain a 2-in-1.

Does anyone utilize a 3-in-1 PPN (peripheral) formulation at their site? Thank you kindly.

-Mack-