Does anyone have a process that allows providers to obtain medications for use outside of hospital-approved protocol?

We had a provider requesting a medication for use outside of a protocol one evening and was told no. Provider did nothing however escalated the day with the request going to the P&T Committee. After much discussion around pharmacy just giving the medication with subsequent review, the decision was made to table while more research is gathered. One task was to see how other institutions handle these situations so reaching out for options. Thank you.

Hello,
What do you do in the event patient requests a prn pain medication to treat lesser pain when patient has a higher level of pain. For example, patient has a prn pain medication for moderate pain for Oxycodone 10 mg and prn pain medication for severe pain for Hydromorphone IV. Patient has a severe pain (level 8-10), however prefers to get Oxycodone that is intended to treat moderate pain. What do your nurses do in this situation?

We have historically always dispensed long acting insulin (glargine) by drawing up patient specific syringes in the pharmacy in 2 batches per day. Our ops team is interested in stocking long acting insulin vials in the Omnicell machines. Has anyone been successful with stocking vials in automation for nursing to draw up? We do have label printers at each omniell that we would utilize to print patient specific labels with barcodes.
Please let us know if you have pharmacy services 24/7 when you reply. Thanks so much!

At your organization, do you use ceftriaxone in neonates? If so, can you please share your criteria for use?
Additional questions:
- Do you have any electronic (EMR) safeguards in place to alert if a patient has received IV calcium containing products 48 hours prior and post 48 hours of ceftriaxone?
a) If yes, Does the alert capture one-time doses or doses administered in the ED or OR? Can you please share how the alert is built?
b) If no, Are there non-EMR safeguards in place?

Who is your MRI Pump vendor? Having an issue where our pump vendor cannot safely accommodate medications that are dosed in units, such as Vasopressin and Insulin. These cannot be programmed as decimals and therefore force the nurse to run in basic (volume/time) mode. DO you have these meds in your MRI pump library?

We have recently had a few of our orthopedists and anesthesiologists inquire about using low dose methadone peri-operatively at doses of 0.1-0.3mg/kg and was curious if any of your facilities had any related experiences you'd care to share. Obviously, with methadone's t1/2 of 12-60 hours, even considering using long-acting opioids for acute pain management gives me significant pause,b ut would also be concerned about QTc effects with increased methadone use. Thoughts?

We have recently had a few of our orthopedists and anesthesiologists inquire about using low dose methadone peri-operatively at doses of 0.1-0.3mg/kg and was curious if any of your facilities had any related experiences you'd care to share. Obviously, with methadone's t1/2 of 12-60 hours, even considering using long-acting opioids for acute pain management gives me significant pause,b ut would also be concerned about QTc effects with increased methadone use. Thoughts?

At your organizations do you share a report of all medication errors with your whole medication safety team? Or do you present highlights and trends? For us, every event is already reviewed by pharmacy, the department manager, risk/patient safety manager, and CI if needed. Is there a need for the whole team to review them (ie managers of other units for example)? Thank you!

Due to a few recent event reports relating to entry of verbal orders into Epic, we are in the process of reviewing the frequency/extent of verbal order entry at our facility. Our current policy states that verbal orders should be used "infrequently" and when it is "impossible/impractical" for the ordering provider to enter the orders themselves. Has anyone had to address a similar situation at their own facility?

Situation: The DKA calculator we have in Epic pulls weights from prior encounters for the initial insulin infusion dosing and errors have occurred secondary to old/incorrect weights being entered.

Background: Our system has a rule in place for all patients >18 years old that allows for a 2 day lookback at prior encounters for a weight. In some instances, a weight might be inaccurate compared to the weight in the current encounter either due to ‘stated weights’ being used, or differences in scale calibration.