Have any institutions been asked to load concentrated ketamine (100 mg/ml) in the ED ADM? We currently have the 10 mg/ml strength loaded, but the concentrated ketamine is sent from the Pharmacy patient-specific.

This request from the ED seems to surface about every 6 months. We have shared with them the Vermont ketamine overdose story and various ISMP newsletters, but the ED providers seem to be pretty insistent on having the medication on hand. A couple other pieces of information: The ED ADM is currently non-profiled at our organizaton (we're not there yet) AND the concentrated ketamine is used for off label indication in the ED (administered IM for excited delirium).

For those who have been in this same situation, I would very much like to hear how your institution handled the situation. Did you stand firm on not loading it? Or do you have BOTH concentrations of ketamine available in the ED? If the latter, then what measures have you taken to ensure its safe use?

I would appreciate any and all advice. Thank you in advance.