Hello everyone,

Our pediatric CVICU nurses have recently brought a concern to the attention of the Medication Safety Committee at our facility, the concern is regarding continuous Lasix and Bumex infusions being added to the high alert medication list and requiring dual sign off with administration/titrations. Within this patient population, diuretic dosing errors can lead to patient harm and our CVICU nurses feel strongly that these infusions require a dual sign off.

Hello,
I will piggyback on the last topic on insulin pens. I would like to find out how others are dispensing insulin in the hospitals. My hospital system of 22 hospitals do a mix of insulin pens, community vial, and patient specific vial. We are working on a standardization project and as you can expect, this is not an easy task when diabetes educators, infection prevention, nursing, and pharmacy are involved.

Hello!

For sites that do not typically stock insulin pens inpatient, how do you approach the patient assessment and teaching for new insulin pen starts prior to discharge? If the teaching/assessment is handled by nursing, what kind of competency do you require?

For institutions that have eliminated promethazine injectable from formulary, what alternative agents have you substituted with for pediatric patients? I'd greatly appreciate any feedback and guidance. Thank you.

Dear MSOS Members:

I have some questions about your Hypertonic Saline orders for Severe Hyponatremia.

1. Do your EHR orders or paper orders have comments asking clinicians to identify and reconcile other sources of sodium chloride the patient is receiving before determining the initial infusion rate of 3% sodium chloride? If so, may you please share the wording?

2. Do your electronic orders or paper orders have a calculator or a formula for determining sodium deficit and initial infusion rate for 3% sodium chloride?

Hello, at our facility we utilize Heparin infusions for: therapeutic anticoagulation, Impella purge solutions (but may be changing soon), as well as a continuous infusion after a peripheral revascularization procedure. The first two infusions are run in doses of units/kg/hr, requiring a patient weight to be entered into the smart pump. The last type of infusion is ordered as a continuous, non-titrated infusion of a set dose of units/hr. We switched to the BBraun Infusomat Space LVP in February, and since then, have had multiple errors related to nursing choosing the wrong heparin entry.

Hello,
On occasion when a patient's response to an infusion is not as expected, providers have requested potency testing (eg. alprostadil, bivalirudin). Potency testing is useful to rule out dispensing errors, but not other causes. We are hoping to develop a process to review potential infusion errors, including sequestering the device and medication/tubing, review pump data, review patient case, etc.

Does anyone have a process and/or policy to investigate potential errors with smart infusion pumps? Thank you!

Pharmacy has been approached by nursing staff to help create a list of medications (subq/IM) that LPNs can administer. Goal for our nursing staff is to have one RN oversee 1 LPN and share patients. Has anyone had to create a list? Possibly only allow oral medications to be given by LPNs and no IV/Subq/IM. Michigan law allows LPNs to administer drugs under RN supervision.

I am working to develop a checklist of sorts to evaluate the many templates of label types available within EPIC.
Does anyone have a checklist or any ideas to consider when developing this for a proactive evaluation tool?

For example: 2 patient identifiers - which 2?