JDJ Consulting

PRODUCT RECALL

John Karwoski — Wed, 11 Mar 2009 20:40:21 +0000

January, 2009

John Karwoski — Mon, 19 Jan 2009 21:33:33 +0000

Let’s start out 2009 with an emergency response question!

Question: Explain your role in responding to a Malignant Hypertherma crisis.

Answer: Multiple tasks should take place when the anouncement of MH is heard. It is important for everyone to know who is to respond and how to respond. JDJ Consulting performs MH drills annually to all clients. If you have questions or need additional assistance please contact us at: john@jdjconsulting.net.

Medication Reconciliation

John Karwoski — Mon, 19 Jan 2009 21:21:40 +0000

Medication reconciliation remains one of The Joint Commission’s 2009 National Patient Safety Goals, but the elements of performance that will apply beginning in 2009 were revised to reflect some of the challenges that ASCs and other small entities encountered in complying with the goal. After ASC Association Treasurer Jerry Henderson, CASC, of Lifebridge shared the concerns of ASCs with this National Patient Safety Goal with The Joint Commission at a summit it held last year, The Joint Commission reconsidered its performance criteria. The goal—to accurately and completely reconcile medications across the continuum of care—remains the same. To address situations “where medications are used minimally, or prescribed for a short duration,” however, The Joint Commission created a modified reconciliation process that ASCs and others can use. The modified process still requires that the organization obtain an accurate list of the patient’s current medications and known allergies so that any prescriptions written during the visit are appropriate. But in situations where only short-term medications are used, the patient needs to be provided only the list of the short-term medications that he or she needs to take after leaving the facility. In such situations, the original list does not need to be provided to the patient. If the patient is confused or unable to comprehend adequately, however, the patient’s family needs to be provided with the original medication list as well as the short-term medication list. This new process can not be used if any new long-term medications are prescribed, if there is a change in any current long-term medications or if the patient is admitted to a facility for ongoing care. Pages 44–49 of the January/February 2008 issue of ASC Focus contain an article on ASC compliance with medication reconciliation. The article is also available at www.ascassociation.org/medrecarticle.pdf. Microsoft Word® versions of the forms featured in the article, which users can download and complete electronically, are available at www.ascassociation.org/medrec.doc.

December, 2008

John Karwoski — Sun, 04 Jan 2009 21:42:34 +0000

This completes the first year for the “Question of the Month.” We have received alot of wonderful feedback and look forward to keeping the questions coming. Patient safety is the foundation for the “Question of the Month” and I hope you are learning while enjoying it. If you have suggestions, please send them to us.

Happy New Year!

November, 2008

John Karwoski — Sun, 04 Jan 2009 21:30:50 +0000

Question: Name the official “DO NOT USE” abbreviation list?

(hint: there are 5 items)

Answer: 1. U for unit

2. IU for international unit

3. QD, QOD for daily, every other day

4. trailing zero and lack of leading zero

5. MS, MSO4, MgSO4 for morphine and magnesuim sulfate.

October, 2008

John Karwoski — Fri, 14 Nov 2008 00:47:22 +0000

Question: Discuss the indications and administration of Adenosine in a code?

Answer: Treatment of paroxysmal supraventricular tachycardia (PSVT) including that associated with accessory bypass tracts (Wolff-Parkinson-White syndrome); when clinically advisable, appropriate vagal maneuvers should be attempted prior to adenosine administration; not effective in atrial flutter, atrial fibrillation, or ventricular tachycardia

Paroxysmal supraventricular tachycardia (Adenocard®): I.V. (rapid - over 1-2 seconds, via peripheral line): 6 mg; if not effective within 1-2 minutes, 12 mg may be given; may repeat 12 mg bolus if needed; maximum single dose: 12 mg.

Follow each I.V. bolus of adenosine with normal saline flush.

High alert medication: The Institute for Safe Medication Practices (ISMP) includes this medication among its list of drugs which have a heightened risk of causing significant patient harm when used in error.

September, 2008

John Karwoski — Thu, 13 Nov 2008 20:42:58 +0000

QUESTION: What is the dilution and rate of administration of Magnesium Sulfate in an emergency?

ANSWER: 50% Magnesium Sulfate Injection, USP must be diluted to a concentration of 20% or less prior to I.V. infusion (typically 1-2 gm diluted in 50-100ml NSS). Rate of administration should be slow and cautious, to avoid producing hypermagnesemia. The 50% solution also should be diluted to 20% or less for intramuscular injection in infants and children. The adverse effects of parenterally administered magnesium usually are the result of magnesium intoxication. These include flushing, sweating, hypotension, depressed reflexes, flaccid paralysis, hypothermia, circulatory collapse, cardiac and central nervous system depression proceeding to respiratory paralysis. Magnesium intoxication is manifested by a sharp drop in blood pressure and respiratory paralysis. Disappearance of the patellar reflex is a useful clinical sign to detect the onset of magnesium intoxication. In the event of overdosage artificial ventilation must be provided until a calcium salt can be injected intravenously to antagonize the effects of magnesium.

For Treatment of Overdose

Artificial respiration is often required. Intravenous calcium, 10 to 20 mL of a 5% solution (diluted if desirable with isotonic sodium chloride for injection) is used to counteract effects of hypermagnesemia. Subcutaneous physostigmine, 0.5 to 1 mg may be helpful.

August, 2008

John Karwoski — Thu, 28 Aug 2008 17:31:28 +0000

Question? What is USP 797?

Answer: The United States Pharmacopeia (USP) is the official public standards-setting authority for all prescription and over-the-counter medicines, dietary supplements, and other healthcare products manufactured and sold in the United States. USP sets standards for the quality of drug products and works with healthcare providers to help them meet the standards. Chapter 797 will affect anyone or any facility that handles injectables and other products that require sterility. This includes injections, aqueous bronchial and nasal inhalations, baths and soaks for live organs and tissues, irrigations for wounds and body cavities, ophthalmic drops and ointments, and tissue implants. USP 797 went through its final revision approval in December. The new standard becomes official June 1, 2008.

Please contact JDJ Consulting for assistance in meeting these standards.

July, 2008

John Karwoski — Fri, 25 Jul 2008 21:26:17 +0000

Question: What drugs can trigger Malignant Hyperthermia?

Answer: All of the volatile inhalation anesthestics and one muscle relaxant, Succinycholine.

Remember, JDJ Consulting offers annual MH drills to all current clients.

FDA ALERT [7/8/2008] Fluoroquinolone Antimicrobial Drugs

John Karwoski — Sat, 12 Jul 2008 01:21:45 +0000

Please click on the links below to access FDA info on the Fluoroquinolone Antimicrobial Drugs.

http://www.fda.gov/bbs/topics/NEWS/2008/NEW01858.html

http://www.fda.gov/cder/drug/InfoSheets/HCP/fluoroquinolonesHCP.htm

http://www.fda.gov/cder/drug/infopage/fluoroquinolones/default.htm

Contact JDJ Consulting for additional information.