Download for 2016-2017 - Pennsylvania Society of Health

INSTITUTE OF SAFE MEDICATION PRACTICES
(ISMP)
2016-2017 TARGETED MEDICATION SAFETY
BEST PRACTICES FOR HOSPITALS
Laura J. Haynes, PharmD, BCPS
Clinical Pharmacy Specialist, Medication Safety
Hospital of the University of Pennsylvania
Department of Pharmacy
October 12th, 2016
DISCLOSURE
• There are no disclosures to report at this time.
OBJECTIVES
PHARMACIST
1.
2.
3.
4.
Identify the 2016-2017 ISMP
standards
Understand the literature
behind all of the 2016-2017
ISMP standards
Evaluate the current
recommendations prepared
by ISMP for deficiencies in
their practice sites
Find new ISMP standards to
execute into their practice
site
PHARMACY TECHNICIAN
1.
2.
3.
4.
Identify the 2016-2017 ISMP
standards associated with high
alert medications
Understand the reasoning
behind the new 2016-2017
ISMP standards
Examine the current
recommendations as options to
consider for implementation into
their hospital/practice sites
Recognize opportunities for
technicians to become involved
in implementation from the new
ISMP standards reviewed
ISMP BACKGROUND
HISTORY OF ISMP
• Only nonprofit organization devoted entirely to prevention
of medication errors and safe use of medications.
• Mission - Identify common medication errors, to perform
root cause analyses, and to make recommendations to
health care providers, health systems, and
pharmaceutical industries to reduce medication errors.
Institute of Safe Medication Practices. About ISMP. Available at: http://www.ismp.org/about/default.aspx. Accessed April 20, 2016.
HISTORY OF ISMP
2005
2001
1998
1991
1987
• ISMP
releases its
first list of
dangerous
medical
abbreviations
• National,
Confidential,
voluntary
medication
error reporting
program
(MERP) was
created
• Release of the
first high-alert
medication list
• Requests FDA to
require tall man
lettering for
“look-alike,
sound-alike”
drugs
• The Joint
Commission
releases new
2006 Patient
Safety Goal
requiring
labeling of all
medications,
medication
containers, or
other solutions
Institute of Safe Medication Practices. Historical Timeline. Available at: http://www.ismp.org/about/timeline.aspx. Accessed April 20, 2016.
ISMP RESOURCES
Special Medication
Hazard Alert
Searchable
Information
Pathways for
Medication Safety
Tools
Frequently Asked
Questions
Information on barcode technology
and electronic
prescribing
FDA Patient Safety
Videos
Message Board
Institute of Safe Medication Practices. Learn About Us. Available at: http://www.ismp.org/about/ismp-decade.pdf. Accessed April 20, 2016.
TARGETED
MEDICATION SAFETY
BEST PRACTICES
2016-2017
2016-2017 TARGETED MEDICATION
SAFETY BEST PRACTICES
1.
Dispense vinCRIStine in a minibag, not syringes
2.
Safe administration and error prevention of oral methotrexate
3.
Record patient weight in kilograms
4.
Dispense oral liquids in unit doses or oral syringes
5.
Oral liquid dosing devices should only display metric units
6.
Eliminate glacial acetic acid from all areas of hospital
7.
Segregate, sequester, and differentiate neuromuscular blocking agents
8.
Administer high-alert IV medications via programmable infusion pumps
9.
All antidotes, reversal agents, and rescue agents must be readily
available
10. Eliminate all 1L bags of sterile water
11. Appropriate verification techniques when preparing compounded
sterile products
ISMP. 2016-2017 Targeted Medication Safety Best Practices for Hospitals. Available at: http://www.ismp.org/tools/bestpractices/TMSBP-forHospitals.pdf. Accessed on April 20, 2016.
BEST PRACTICE 1
• Dispense vinCRIStine (and other vinca alkaloids) in a
minibag of a compatible solution and not in a syringe.
ISMP. 2016-2017 Targeted Medication Safety Best Practices for Hospitals. Available at: http://www.ismp.org/tools/bestpractices/TMSBP-forHospitals.pdf. Accessed on April 20, 2016.
RATIONALE
• VinCRIStine has been accidentally administered
intrathecally.
• When given this route, the results are often fatal.
• If patients do survive, they suffer from permanent neurological
damage.
• This error can occur often since vinca alkaloids are
routinely ordered with medications that are administered
intrathecally.
• By diluting medication into a minibag, errors and
confusion with intrathecal syringes can be prevented.
Clin J Oncol Nurs 2006;10(2):271-3
ISMP. Fatal Misadministration of IV Vincristine. ISMP Medication Safety Alert! Acute Care 2005. ISSN 1550-6312
Woods K. The Prevention of Intrathecal Medication Errors. London, UK: UK Department of Health. 2001. 1-24.
PRACTICE RECOMMENDATIONS
• Vinca alkaloids should be
placed into minibags to stop
the confusion of syringes.
• Minibags should be diluted to
25mL for pediatric patients and
50mL for adults.
• Labels should be placed onto
bags saying “FOR
INTRAVENOUS USE ONLY –
FATAL IF GIVEN BY OTHER
ROUTES”
Clin J Oncol Nurs 2006;10(2):271-3.
ISMP. 2016-2017 Targeted Medication Safety Best Practices for Hospitals. Available at: http://www.ismp.org/tools/bestpractices/TMSBP-for-Hospitals.pdf.
Accessed on April 20, 2016.
BEST PRACTICE 2
a) Use a weekly dosage regimen default for oral
methotrexate in electronic systems when medication
orders are entered.
b) Require a hard stop verification of an appropriate
oncologic indication for all daily oral methotrexate
orders.
c) Provide specific patient and/or family education for all
oral methotrexate discharge orders.
ISMP. 2016-2017 Targeted Medication Safety Best Practices for Hospitals. Available at: http://www.ismp.org/tools/bestpractices/TMSBP-for-Hospitals.pdf.
Accessed on April 20, 2016.
RATIONALE
Daily Administration
Indications
• Acute Lymphoblastic
Leukemia (ALL)
• Choriocarcinoma/
Chorioadenoma
Weekly Administration
Indications
• Cutaneous T-Cell
Lymphoma
• Psoriasis
• Rheumatoid Arthritis
• Systemic Lupus
Erythematosus (SLE)
Methotrexate. Lexi-Drugs. Lexicomp. Wolters Kluwer Health, Inc. Hudson, OH. Available at:http://online.lexi.com. Accessed April 20, 2016.
PRACTICE RECOMMENDATIONS
• Incorporate hard stop verification when ordering oral MTX
• Default ordering should be weekly dosing
• Clarify all daily orders with physicians, especially for patients with
no oncologic indication listed
• Provide patients with ISMP high-alert medication
consumer leaflet
• Provide written and verbal instructions regarding MTX
• Double check all med lists and discharge instructions
ISMP. 2016-2017 Targeted Medication Safety Best Practices for Hospitals. Available at: http://www.ismp.org/tools/bestpractices/TMSBP-for-Hospitals.pdf.
Accessed on April 20, 2016.
ISMP. Methotrextate. Available at: http://www.ismp.org/tools/highalertMedications/methotrexate.pdf Accessed on April 20, 2016.
ASSESSMENT
Which of the following would NOT be good practices to
ensure safe methotrexate usage for patients?
A. Default electronic ordering for daily methotrexate dosing
B. Requirement for indication for use within medication
order
C. Education to patients about how to take medication as
prescribed
D. Communicate side effects to patients be aware of when
taking methotrexate
BEST PRACTICE 3
a) Weigh each patient as soon as possible on admission
and during each appropriate outpatient or emergency
department encounter. Avoid the use of a stated,
estimated, or historical weight.
b) Measure and document patient weights in metric units
only.
ISMP. 2016-2017 Targeted Medication Safety Best Practices for Hospitals. Available at: http://www.ismp.org/tools/bestpractices/TMSBP-forHospitals.pdf. Accessed on April 20, 2016.
RATIONALE
• In 2012, the Emergency Nurses Association and the
American Academy of Emergency Medicine released a
joint statement requesting for weights to be measured
only in kilograms.
• Emergency rooms have the one of the highest medical error rates.
• Additionally, up to 18% of preventable medication errors are due to
not having essential information at the time of prescribing,
dispensing, and administering medications, such as weight.
• Additionally, drug dosing typically uses kilograms to
appropriately dose patients.
Emergency Nurses Association. Weighing Patients in Kilograms. 2012.
ISMP. 2016-2017 Targeted Medication Safety Best Practices for Hospitals. Available at: http://www.ismp.org/tools/bestpractices/TMSBP-for-Hospitals.pdf.
Accessed on April 20, 2016.
PRACTICE RECOMMENDATIONS
• Remove or replace all scales that cannot weigh patients
in kilograms.
• In electronic medical records, remove the ability to record
weights in pounds.
• When speaking to patients, disclose their weight in
kilograms.
ISMP. 2016-2017 Targeted Medication Safety Best Practices for Hospitals. Available at: http://www.ismp.org/tools/bestpractices/TMSBP-for-Hospitals.pdf.
Accessed on April 20, 2016.
BEST PRACTICE 4:
• Ensure that all oral liquids
that are not commercially
available as unit dose
products are dispensed by
the pharmacy in an oral
syringe.
• Use syringes that either have
“Oral Use Only” marked or
use an auxiliary stating “Oral
Use Only”
ISMP. 2016-2017 Targeted Medication Safety Best Practices for Hospitals. Available at: http://www.ismp.org/tools/bestpractices/TMSBP-for-Hospitals.pdf.
Accessed on April 20, 2016.
RATIONALE
• In 2012, ISMP published “Avoiding Inadvertent IV
Injection of Oral Liquids”
• It is very easy for nurses to confuse regular syringes and oral
syringes.
• Although there is an inability to connect oral syringes to the IV port,
misadministration still occurs and can cause deleterious effects.
• When administering an oral liquid via IV, there is a risk of
embolus, infection, and possible presence of unsafe
ingredients in the vasculature.
ISMP. Avoiding Inadvertent IV Injection Of Oral Liquids. 2012. Available at: http://www.ismp.org/Newsletters/acutecare/showarticle.aspx?id=29. Accessed April
20, 2016.
PRACTICE RECOMMENDATIONS
• ISMP makes the following suggestions to prevent
misadministration of oral liquids:
• Use different colored syringes to differentiate between
oral syringes and parenteral syringes.
• Place auxiliary labels on oral syringes which state “FOR
ORAL USE ONLY”.
• Purchase syringes that are unable to connect to IV
ports.
• Commercially available bulk bottles should never be
dispensed.
• Educate newly graduated nurses about the perils of
misadministration of oral liquids.
ISMP. 2016-2017 Targeted Medication Safety Best Practices for Hospitals. Available at: http://www.ismp.org/tools/bestpractices/TMSBP-for-Hospitals.pdf.
Accessed on April 20, 2016.
ISMP. Avoiding Inadvertent IV Injection Of Oral Liquids. 2012. Available at: http://www.ismp.org/Newsletters/acutecare/showarticle.aspx?id=29. Accessed April
20, 2016.
BEST PRACTICE 5
• Purchase oral liquid dosing devices (oral
syringes/cups/droppers) that only display the metric scale.
• If patients are being discharged with oral liquids, ensure
they receive oral syringes and are educated about
measuring medication in mL.
ISMP. 2016-2017 Targeted Medication Safety Best Practices for Hospitals. Available at: http://www.ismp.org/tools/bestpractices/TMSBP-forHospitals.pdf. Accessed on April 20, 2016.
RATIONALE
• “A teaspoon” can be confused
and can mean different things to
patients.
• Can be complicated further if a
patient has poor health literacy
or does not speak English as
their first language
• Example:
• Augmentin 125mg/5mL - Take 2
teaspoons by mouth every 12 hours
ISMP. 2016-2017 Targeted Medication Safety Best Practices for Hospitals. Available at: http://www.ismp.org/tools/bestpractices/TMSBP-forHospitals.pdf. Accessed on April 20, 2016.
PRACTICE RECOMMENDATIONS
• Metric units (such as mL) should be the only measurements used,
rather than teaspoons and non-metric measurements.
• This jargon should be updated within electronic ordering systems
and other electronic systems.
• Ensure that prescribers are also prescribing in metric units.
• Provide patients with the proper measuring cups or syringes so that
they can properly administer oral liquids at home.
• Teach patients how to properly use and clean devices.
• Ask patients to teach back to you.
• For oral liquids, patient weights should be measured and expressed
in kilograms.
ISMP. 2016-2017 Targeted Medication Safety Best Practices for Hospitals. Available at: http://www.ismp.org/tools/bestpractices/TMSBP-forHospitals.pdf. Accessed on April 20, 2016.
ASSESSMENT
Which of the following would be an ISMP recommended
measurement unit for medication
ordering/dosing/administration?
A.
B.
C.
D.
E.
F.
Pounds (lbs)
Kilograms (kg)
Grains (gr)
Teaspoon/Tablespoons (tsp/tbsp)
Milliliters (mL)
More than one of the above
BEST PRACTICE 6
• Eliminate glacial acetic acid (99.5%) from all clinical areas
of the hospital.
ISMP. 2016-2017 Targeted Medication Safety Best Practices for Hospitals. Available at: http://www.ismp.org/tools/bestpractices/TMSBP-forHospitals.pdf. Accessed on April 20, 2016.
RATIONALE
• In January 2013, a warning was issued regarding glacial
acetic acid and its ability to cause 3rd degree burns and
tissue damage.
• This error occurred due to confusing labeling regarding
glacial acetic acid.
National Alert Network. WARNING! Severe Burns and Permanent Scarring After Glacial Acetic Acid (>99.5%) mistakenly applied
topically. Available at: http://www.ismp.org/NAN/files/20130121.pdf. Accessed on: April 20, 2016.
PRACTICE RECOMMENDATIONS
Remove
from stock
(particularly
the floor)
Restrict
choices
when
purchasing
any acetic
acid
products
Ensure
correct
strength is
ordered
Educate
staff about
different
uses of
acetic acid
Prescribe
5% acetic
acid as
“vinegar”
Verify
product
being
prescribed
National Alert Network. WARNING! Severe Burns and Permanent Scarring After Glacial Acetic Acid (>99.5%) mistakenly applied
topically. Available at: http://www.ismp.org/NAN/files/20130121.pdf. Accessed on: April 20, 2016.
BEST PRACTICE 7
• Segregate, sequester, and differentiate all neuromuscular
blocking agents (NMBs) from other medications, wherever
they are stored in the organization.
ISMP. 2016-2017 Targeted Medication Safety Best Practices for Hospitals. Available at: http://www.ismp.org/tools/bestpractices/TMSBP-forHospitals.pdf. Accessed on April 20, 2016.
RATIONALE
Look-alike Packaging and Labeling
Look-alike Drug Names
Drug Administration After Extubation
Unsafe Storage
Lack of Knowledge
ISMP. Paralyzed By Mistakes: Preventing Errors with Neuromuscular Blocking Agents. ISMP Medication Safety Alert! Acute Care 2005. Available at:
https://www.ismp.org/newsletters/acutecare/articles/20050922.asp. Accessed on April 20, 2016
PRACTICE RECOMMENDATIONS
• Utilize modalities to prevent unintended use
• Classify these medications as high alert
• Sequester all NMBs away from other medications
• Warnings and prompts in electronic ordering systems
• Warning labels should be placed on all vials
ISMP. 2016-2017 Targeted Medication Safety Best Practices for Hospitals. Available at: http://www.ismp.org/tools/bestpractices/TMSBP-for-Hospitals.pdf.
Accessed on April 20, 2016.
QUESTION 3
Name a method(s) to reduce errors relating to
neuromuscular blocking agents (NMBs).
A. Store NMBs separate from other medications
B. Label these medications as high-alert
C. Place labels and stickers on vials or syringes of
medication to avoid confusion
D. All of the above
BEST PRACTICE 8
• Administer high-alert intravenous (IV) medication
infusions via a programmable infusion pump utilizing
dose-reduction software.
ISMP. 2016-2017 Targeted Medication Safety Best Practices for Hospitals. Available at: http://www.ismp.org/tools/bestpractices/TMSBP-for-Hospitals.pdf.
Accessed on April 20, 2016.
HIGH ALERT MEDICATIONS
Categories of Medications
Adrenergic
Agonists
Dextrose,
hypertonic, 20%
or greater
Adrenergic
Antagonists
Dialysis Solutions Narcotics
Anesthetic
Agents
Epidural or
intrathecal
medications
Anti-arrhythmics
Antithrombotic
Agents
Cardioplegic
Solutions
Chemotherapy
Specific Drugs
Epoprostenol, IV
Sedating Agents
Magnesium Sulfate, injection
Opium Tincture
Oxytocin, IV
Neuromuscular
Blocking Agents
Nitroprusside sodium,
injection
Hypoglycemics
PO
Inotropic
medications
Parenteral
Nutrition
Potassium Chloride, injection
Insulin
Sterile water
Promethazine, IV
Radiocontrast IV
Sodium Chloride
Liposomal forms for injection,
of drugs
hypertonic,
greater than 0.9%
ISMP. ISMP List of High-Alert Medications in Acute Care Settings. Available at: http://www.ismp.org/Tools/institutionalhighAlert.asp. Accessed on April 20, 2016.
RATIONALE
• ISMP states that high alert medications are have a
“heightened risk of causing significant patient harm when
used in error.”
• In 2007, ISMP published an article, “Smart pumps are not
smart on their own”, discussing the limitations of using
smart pumps.
• Although they can help reduce errors in dosing, they are not fool-
proof
• Bypassing dosing warnings can lead to serious patient harm and
dire consequences
ISMP. Smart Pumps Are Not Smart On Their Own. ISMP Medication Safety Alert! Acute Care 2007. Available at:
https://www.ismp.org/newsletters/acutecare/articles/20070419.asp. Accessed on April 20, 2016
https://www.ismp.org/newsletters/acutecare/articles/20070
419.asp
PRACTICE RECOMMENDATIONS
• Create a culture of safety
• Ask colleagues to report unsafe behaviors, such as
bypassing dose checks.
• Ensure that alerts are appropriate and useful
• Update dosing and alerts often to ensure that they
align with hospital guidelines
ISMP. Smart Pumps Are Not Smart On Their Own. ISMP Medication Safety Alert! Acute Care 2007. Available at:
https://www.ismp.org/newsletters/acutecare/articles/20070419.asp. Accessed on April 20, 2016
BEST PRACTICE 9
a) Ensure all appropriate antidotes, reversal agents, and
rescue agents are readily available.
b) Have standardized protocols and/or coupled order sets
in place that permit the emergency administration of all
appropriate antidotes, reversal agents, and rescue
agents used in the facility.
c) Have directions for use/administration readily available
in all clinical areas where the antidotes, reversal agents,
and rescue agents are used.
ISMP. 2016-2017 Targeted Medication Safety Best Practices for Hospitals. Available at: http://www.ismp.org/tools/bestpractices/TMSBP-for-Hospitals.pdf.
Accessed on April 20, 2016.
ANTIDOTES & REVERSAL AGENTS
Protamine
+
Heparin
Naloxone
+
Opiates
Flumazenil
+
Benzodiazepines
Naltrexone
+
Alcohol
N-acetylcysteine
+
Acetaminophen
Epinephrine
+
Anaphylaxis
RATIONALE
• There are two major concerns related to antidotes,
reversal agents, and rescue agents:
• If there is a delay in administration of these agents, there can be
fatal consequences to patients.
• With incorrect administration (and even proper dosing), these highalert agents can cause adverse reactions that can also cause harm
or be fatal.
ISMP. 2016-2017 Targeted Medication Safety Best Practices for Hospitals. Available at: http://www.ismp.org/tools/bestpractices/TMSBP-forHospitals.pdf. Accessed on April 20, 2016.
PRACTICE RECOMMENDATIONS
• Store reversal agents in a safe space where they are
readily available, but protected.
• Create protocols that allow these medications to be
retrieved without prescriber orders
• Ensure that directions for use are readily available to
avoid delays or improper use
ISMP. 2016-2017 Targeted Medication Safety Best Practices for Hospitals. Available at: http://www.ismp.org/tools/bestpractices/TMSBP-forHospitals.pdf. Accessed on April 20, 2016.
ASSESSMENT
True or False:
Antidotes and reversal agents cannot be accessed without
an order from a provider accordingly to current pharmacy
law and The Joint Commission Medication Management
Standards.
False
BEST PRACTICE 10
• Eliminate all 1,000 mL bags of sterile water (labeled for
“injection,” “irrigation,” or “inhalation”) from all areas
outside of the pharmacy.
ISMP. 2016-2017 Targeted Medication Safety Best Practices for Hospitals. Available at: http://www.ismp.org/tools/bestpractices/TMSBP-forHospitals.pdf. Accessed on April 20, 2016.
RATIONALE
• Can cause life threatening hemolysis
• 1L bags of sterile water look very similar to 1L bags
of normal saline and dextrose.
• These can be easily confused and can cause harm
to patients.
ISMP. 2016-2017 Targeted Medication Safety Best Practices for Hospitals. Available at: http://www.ismp.org/tools/bestpractices/TMSBP-for-Hospitals.pdf. Accessed on April 20,
2016.
ISMP. Hazard Alert! Don’t Give Large Volumes of Sterile Water IV. ISMP Medication Safety Alert! Nurse Advise-ERR 2007. Available at:
https://www.ismp.org/newsletters/acutecare/articles/20070419.asp. Accessed on April 20, 2016
PRACTICE RECOMMENDATIONS
• ISMP recommends to remove all 1 L bags of sterile water
from patient care areas.
• Only store in the pharmacy to prevent inadvertent
misadministration.
• Consider ordering 2 L IV bags instead.
• If bags cannot be removed from patient care units, then
continual education is key!
• Physicians, nurses, and pharmacists need to understand the
implications and uses of different IV fluids.
• Place large labels on bags that state “NOT FOR DIRECT
INFUSION”, “FOR DILUENT USE ONLY”.
ISMP. 2016-2017 Targeted Medication Safety Best Practices for Hospitals. Available at: http://www.ismp.org/tools/bestpractices/TMSBP-for-Hospitals.pdf.
Accessed on April 20, 2016.
BEST PRACTICE 11
• When compounding sterile preparations, perform an
independent verification to ensure that the proper
ingredients (medications and diluents) are added,
including confirmation of the proper amount (volume) of
each ingredient prior to its addition to the final container.
ISMP. 2016-2017 Targeted Medication Safety Best Practices for Hospitals. Available at: http://www.ismp.org/tools/bestpractices/TMSBP-for-Hospitals.pdf.
Accessed on April 20, 2016.
RATIONALE
• Even with standards and guidance (USP <797>), there is
wide variability between various practices leading to
errors.
• Errors that occur due to improper sterile compounding
can lead to fatalities.
• “Syringe pull-back method” cannot detect all errors that
may occur with sterile compounding.
• This method can overlook:
• Wrong medication
• Wrong diluent
• Wrong container of medication
ISMP. 2016-2017 Targeted Medication Safety Best Practices for Hospitals. Available at: http://www.ismp.org/tools/bestpractices/TMSBP-for-Hospitals.pdf.
Accessed on April 20, 2016.
ISMP. Technology and Error-Prevention Strategies: Why are we still overlooking the IV room? ISMP Medication Safety Alert! Acute Care. 2015. Available at:
http://www.ismp.org/newsletters/acutecare/showarticle.aspx?id=98. Accessed on April 20, 2016
PRACTICE RECOMMENDATIONS
• Per the 2013 ISMP Guidelines for SAFE Preparation of Sterile Compounds,
the following recommendations were made:
Preparation
• When preparing
any product, the
drugs, diluents,
base solutions, and
other supplies to be
used should be
placed into a basket
or bin
• When possible or
available,
commerciallyprepared, premixed
IV products should
be used
Verification
• Eliminate all proxy
methods of
verification, such
as the syringe pullback method
• Any errors that may
occur during
preparation or
verification should
be identified,
corrected, and
documented.
Documentation
• When verifying, the
following
information should
be recorded: drug
name, base
solution, patientspecific dose,
preparation
calculations, final
volume of the
preparation,
beyond use dating
and identify the
appropriate drug
dosage form
ISMP. 2016-2017 Targeted Medication Safety Best Practices for Hospitals. Available at: http://www.ismp.org/tools/bestpractices/TMSBP-for-Hospitals.pdf.
Accessed on April 20, 2016.
ASSESSMENT
Which of the following would NOT be a safe sterile
compounding technique?
A. Purchase pre-mixed IV products when available
B. Record and verify beyond use dates, calculations, &
volumes
C. Utilize proxy methods, like syringe pull-back method
D. Document any near-miss errors that may occur
E. Place drugs, supplies, syringes, etc. to be used in a
separate bin for each preparation
FINAL ASSESSMENT
Identify the correctly matched complication of
misadministration to the drug.
A.
B.
C.
D.
E.
IV Sterile water – hypernatremia
IT Vincristine – neurological damage
PO Methotrexate – tissue damage and necrosis
IV Vecuronium – immune suppression
Glacial Acetic Acid (topical) – hemolysis
Questions?
INSTITUTE OF SAFE MEDICATION PRACTICES
(ISMP)
2016-2017 TARGETED MEDICATION SAFETY
BEST PRACTICES FOR HOSPITALS
Laura J. Haynes, PharmD, BCPS
Clinical Pharmacy Specialist, Medication Safety
Hospital of the University of Pennsylvania
Department of Pharmacy
October 12th, 2016