Hi all,

We've been experiencing issues with titratable meds being programmed incorrectly in our pumps. Some of the issues stem from the following:
-We don't use range orders, so there is almost always an Epic alert that the MAR dose is incorrect since it rarely matches the original order
-Pumps are routinely programmed to the original dose, rather than the most recently titrated dose
-RNs have to enter a rate into the MAR as a hard stop, rather than the dose, resulting in some confusion at the pump
-All of this contributes to alert fatigue in which soft alerts for guardrails are quickly overridden.

Questions for those who use Epic/Alaris interop:
1) Do you use range orders for your titratable drugs, or some other mechanism to avoid MAR dose alerts?

2) Are you able to successfully use interoperability for titratable orders? If you could show me what that looks like, even better!

3) Could you share some of your guardrails for common titratable meds (heparin, vasopressin, midazolam, for example)?

Appreciate your input!
Thanks,
Kara Thornton
krp4h@uvahealth.org