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Re: JCAHO strikes againFrom: ainsron (ainsron@sbcglobal.net)Mon Dec 6 10:42:13 2004
I think it is a universal solution to a non-existing problem. We had the same request from our pharmacy and therapeutics committee, to use a single concentration of pitocin for all circumstances, because the pharmacy has to mix all routine admixtures. We decided on the admixture of 10 units in 1 liter, because that is the standard for augmentation. It seemed like the least likely to cause problems for nursing, otherwise we would have had to adjust the pump settings for inductions and you and I know that the experienced nurses would "forget" to make the appropriate changes. The nursing staff can still add additional units of pitocin to running IVs on the ward, so if we need to go to 20 units per liter or higher, all we have to do is tell them to add it stat. The same goes in surgery and PACU. Ronald E. Ainsworth -----Original Message----- From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of Braun, R. Daniel Sent: Monday, December 06, 2004 7:54 AM To: Multiple recipients of list OB-GYN-L Subject: JCAHO strikes again I received the following message from our pharmacy today: The Joint Commission has issued guidelines that restrict the admixture of solutions in patient care areas. Nursing will no longer be able to add oxytocin to IV bags. The Pharmacy intends to respond to these guidelines by purchasing premixed oxytocin bags. We need your input to help us select a single premixed bag that is consistent with current protocols. I have placed a copy of the available solutions in your mailbox. The following was my reply: WHAAAAAAAAAAAAAAAAAAAAAAATTTTTTTTTTTTTTTTTTTTTTT??????? How ridiculous can they get?? I would say 20 UNITS in 1000 MILLILITERS and 40 UNITS in 1000 MILLILITERS for Post partal use. AND 10 UNITS per 1000 MILLILITERS for augmentation or induction of labor AND 5 UNITS per 1000 MILLILITERS for augmentation and induction of labor. All of the above should be available in NORMAL SALINE, 5% DEXTROSE in WATER, 5% DEXTROSE in NORMAL SALINE, LACTATED RINGERS, and 5% DEXTROSE in LACTATED RINGERS. That works out to about 20 diferent types of of OXYTOCIN bags Do we trust the skill of the nursing personnell to not get those mixed up????? I mean if they can't draw 10 UNITS from a vial and inject it into 1000 MILLILITERS fo normal saline, how can we trust tehm to pick up the right bag????????????????????? Of course all of them need to be available so that we can get the right one when we need it Any printable comments out there? We're from the JCAHO, and we're here to help you. R. Daniel Braun, MD FACOG Professor of Clinical Obstetrics and Gynecology Department of Obstetrics and Gynecology Indiana University School of Medicine Indianapolis, Indiana
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