Hello group,
I am revisiting phenobarbital prep and administration for neonates and looking for safest practices. I'm mostly focused on loading doses and undiluted drug but open to more general info (65mg/mL and 10mg/mL are both on the ISMP/VON list, with the comment that maintenance doses might be unmeasurable without dilution).

Some specific questions:
- if you allow both diluted and undiluted doses, what is the cutoff for using one concentration or the other? By loading dose vs maintenance, by total dose, other?
- How do you direct providers or pharmacists to choose the correct concentration during ordering/verification?
- What workflows do you have to ensure the full dose is administered and no drug loss in tubing (whether diluted or undiluted)?
- Any smart pump concerns or limitations you have worked through?
- Do you have competencies in place for safe preparation?
- For non-24 hour pharmacies - how (if at all) does your phenobarb prep workflow differ when the pharmacy is open vs closed?

This is a low frequency/high risk scenario for the hospitals I cover so I'm grateful for the expertise in this group! Feel free to email me directly and I will share a summary back to the group: egavin@primehealthcare.com

Thank you!
Erin