By now a lot of sites have probably moved to tenecteplase for stroke . Given that there is an urgency to the medication administration, and everything we know about the emergency department I am wondering what best practices we can share around safety ?
We have had a couple near misses even though the following is in place:
1. double checks on emar
2. order only in order set
3. stickers for dosing and cap dosing on container per pharmacy prior to ADM stocking
4. Robust clinical decision support in Epic
5. "kit" virtually in Omnicell - allowing for pulling out ahead of order =like an override, but not on override

What have you found successful at your facilities ?
We found that 48% of the time, they are documenting after the fact, so most of the
above does not matter.
We were considering removing double co-sign and override.

anybody have thoughts ?
thanks
Laura