Recent OSU College of Pharmacy graduate and current PGY-1 Pharmacy Resident at the Children’s Hospital & Medical Center of Omaha, NE, Guadalupe Ortiz (’15), was invited to Mexico with the head CT Surgeon, Dr. Hammel. During their time there, they planned to establish a pediatric ICU pharmacy for his foundation “Abriendo Corazones.” As part of her residency project, Ortiz blogged about her experiences in Mexico:
Drug Shelf
“1. Took pictures of all the drugs that were set up in the PICU
2. Nurse told me that they do not have ibuprofen in suspension so they use paracetamol suspension po
3. They don’t use filter needs when drawing ampules. They do toss the ampule if they don’t have a ‘clean break’.
4. The nurses draw up all of the medication and there are no double checks for dilution or correct volume.
5. They will draw up the medications (i.e. IV APAP) and will just let it sit in the syringe on the back counter for the whole shift.
6. They don’t wipe the vial tops with alcohol prior to drawing out
7. The nurses have no primary references for dosing, stability, or compatibility of the drugs they are using. Most often, they will just Google it.
8. They don’t label the syringes in their drip machines
9. When they are reconstituting, they don’t wipe the lids with alcohol
10. For the first patient (18kg TET patient)
A. Order: cefalotine 450mg IV diluted in 20cc of NS over 30 min (x3 doses)
B. The nurse reconstitutes the ABX in the 5cc of NS that’s provided
C. Will calculate with ml needed to complete the order (i.e. 2.5ml)
i. She uses two different syringe sizes to draw up the correct amount
ii. To get 2ml, she draws up 2ml in a 50cc syringe and draws up the remaining 0.5ml in a 1ml cc syringe
iii. She adds the 0.5ml to the 2ml (in a 50cc syringe) then she dilutes it with 20cc of NS”
2. Nurse told me that they do not have ibuprofen in suspension so they use paracetamol suspension po
3. They don’t use filter needs when drawing ampules. They do toss the ampule if they don’t have a ‘clean break’.
4. The nurses draw up all of the medication and there are no double checks for dilution or correct volume.
5. They will draw up the medications (i.e. IV APAP) and will just let it sit in the syringe on the back counter for the whole shift.
6. They don’t wipe the vial tops with alcohol prior to drawing out
7. The nurses have no primary references for dosing, stability, or compatibility of the drugs they are using. Most often, they will just Google it.
8. They don’t label the syringes in their drip machines
9. When they are reconstituting, they don’t wipe the lids with alcohol
10. For the first patient (18kg TET patient)
A. Order: cefalotine 450mg IV diluted in 20cc of NS over 30 min (x3 doses)
B. The nurse reconstitutes the ABX in the 5cc of NS that’s provided
C. Will calculate with ml needed to complete the order (i.e. 2.5ml)
i. She uses two different syringe sizes to draw up the correct amount
ii. To get 2ml, she draws up 2ml in a 50cc syringe and draws up the remaining 0.5ml in a 1ml cc syringe
iii. She adds the 0.5ml to the 2ml (in a 50cc syringe) then she dilutes it with 20cc of NS”
Medication Table
PICU Medication Station
There will be a series of 10 posts from Guadalupe. Part 4 in the series will be in the next newsletter.