Slide #1.

Pearls (and perils) of drug administration in the Emergency Department Joshua Villarreal & Jennifer Knutson
More slides like this


Slide #2.

Medication Errors • Affect up to 60% of Emergency Department (ED) patients 1 Patanwala AE, Warholak TL, Sanders AB, et al. A prospective observational study of medication errors in a tertiary care emergency department. Ann Emerg Med.
More slides like this


Slide #3.

Medication Errors • Errors occur during – Prescribing process: 82% – Administration process: 12% – Transcribing and monitoring: 6% 1 Patanwala AE, Warholak TL, Sanders AB, et al. A prospective observational study of medication errors in a tertiary care emergency department. Ann Emerg Med.
More slides like this


Slide #4.

The Eight Rights: Errors @ UWMC ED • Start (or stop) medication – Right Patient – Right Route – Right Drug – Right Dose – Right Time – Right Documentation – Right to Refuse – Right Response
More slides like this


Slide #5.

Right Route: Epinephrine Intramuscular • Anaphylaxis: – 0.3 mg IM – 0.3 mL of a 1:1000 solution Intravenous • Pulseless cardiac arrest – 1mg IV Push – 10 mL of a 1:10,000 solution
More slides like this


Slide #6.

Epinephrine • New Policy Approved at UWMC • For Acute Allergic Reaction: – Route should always be IM – Dose should always be 0.3mg – Concentration should always be 1mg/mL
More slides like this


Slide #7.

Right Drug: Immediate vs. Timed Release • Immediate release: – Drug absorption NOT delayed beyond original pharmacokinetic profile – Immediate release (IR)
More slides like this


Slide #8.

Right Drug: Immediate vs. Timed Release • Timed release – Prolong absorption: Longer dosing intervals & less drug level fluctuation • • • • • • • Sustained-release (SR) Sustained-action (SA) Extended-release (ER, XR, XL) Timed-release (TR) Controlled-release (CR) Modified release (MR) Continuous-release (Contin)
More slides like this


Slide #9.

Right Drug: Immediate vs. Timed Release • Opioids – Oxycodone (IR, CR) – Morphine (IR, ER) • Cardiovascular – – • Metoprolol (IR, XL) Diltiazem (IR, CD) Antidepressants – – Bupropion (IR, SR, XL) Venlafaxine (IR, XR)
More slides like this


Slide #10.

Right Drug: Immediate vs. Timed Release Drug Peak Pyxis Oxycodone (immediate) 1-2 hours YES Oxycodone CR or OxyContin 4-5 hours NO Morphine IR Morphine ER or MSContin 1 hour 4 hours NO YES
More slides like this


Slide #11.

Right Drug: Sound Alike Medications • Metoclopramide vs. Metoprolol • Benadryl vs. Benazapril • Clonazepam vs. Clonidine • Methadone vs. Mephyton • Dobutamine vs. Dopamine
More slides like this


Slide #12.

Right dose: Sedation & Vasoactive Drips • Drip rate errors – Vasoactive drips • Epinephrine – mcg/kg/min • Norepinephrine – mcg/kg/min • Phenylephrine – mcg/kg/min • Dopamine – mcg/kg/min • Dobutamine – mcg/kg/min – Sedation • Propofol – mcg/kg/min
More slides like this


Slide #13.

Right dose: Sedation & Vasoactive Drips • Why so confusing? – Units not universally standard • New providers • Drug information resources – mcg/kg/min vs. mcg/min
More slides like this


Slide #14.

Right dose: Sedation & Vasoactive Drips ICU Drug information Sheets - Starting doses - Titration schedules - Drug administration pearls - Monitoring parameters RED binders - Rooms 1-5 - Contain ICU drug information sheets Code carts - Side of cart - Drip mixing and dosing
More slides like this


Slide #15.

Right dose: Sedation & Vasoactive Drips ICU Drug information Sheets - Starting doses - Titration schedules - Drug administration pearls - Monitoring parameters RED binders - Rooms 1-5 - Contain ICU drug information sheets Code carts - Side of cart - Drip mixing and dosing
More slides like this


Slide #16.

Right dose: Sedation & Vasoactive Drips ICU Drug information Sheets - Starting doses - Titration schedules - Drug administration pearls - Monitoring parameters RED binders - Rooms 1-5 - Contain ICU drug information sheets Code carts - Side of cart - Drip mixing and dosing
More slides like this


Slide #17.

Right dose: Sedation & Vasoactive Drips ICU Drug information Sheets - Starting doses - Titration schedules - Drug administration pearls - Monitoring parameters RED binders - Rooms 1-5 - Contain ICU drug information sheets Code carts - Side of cart - Drip mixing and dosing
More slides like this


Slide #18.

Right dose: Sedation & Vasoactive Drips ICU Drug information Sheets - Starting doses - Titration schedules - Drug administration pearls - Monitoring parameters RED binders - Rooms 1-5 - Contain ICU drug information sheets Code carts - Side of cart - Drip mixing and dosing
More slides like this


Slide #19.

Right Dose: Heparin • Multiple Concentrations: – 1 unit/mL – 10 unit/mL – 1,000 units/mL – 5,000 units/mL – Various infusions – Various rates – Various Targets
More slides like this


Slide #20.

Right Time: Prostacyclin Infusions • Life-sustaining continuous infusions: – Treprostinil (Remodulin) – Epoprostenol (Flolan) http://www.muschealth.com/ph/education/medications.htm
More slides like this


Slide #21.

Prostacyclin Policies • For Patients who present with prostacyclin infusions: – !!!DO NOT INTERRUPT PROSTACYCLIN INFUSION!!! – !!!DO NOT INTERRUPT PROSTACYCLIN INFUSION!!! – !!!DO NOT INTERRUPT PROSTACYCLIN INFUSION!!!
More slides like this


Slide #22.

Prostacyclin Policies • Inform ED Pharmacist of all patients requiring prostacyclin infusion • If no ED Pharmacist, inform inpatient pharmacy • Blood cultures from prostacyclin infusion line need to follow Prostacyclin Infusion Policy
More slides like this


Slide #23.

Prostacyclin Policies • Resources for infusion management or infusion complications: – Stephanie Harrie Nolley, Pulmonary Vascular Nurse Coordinator – STAT nurses – Pharmacists
More slides like this


Slide #24.

Prostacyclin Policies On UWMC Intranet, “Policies and Procedures”
More slides like this


Slide #25.

Prostacyclin Policies Under Patient Care Services, “Nursing Policies and Procedures”
More slides like this


Slide #26.

Prostacyclin Policies
More slides like this


Slide #27.

Questions
More slides like this


Slide #28.

Sepsis + Antibiotics • Sepsis: every minute counts… • Start antibiotics immediately, but which one? And more than one?
More slides like this


Slide #29.

Sepsis + Antibiotics
More slides like this


Slide #30.

Sepsis + Antibiotics
More slides like this


Slide #31.

Questions
More slides like this