Chemotherapy agents (all routes, includes antineoplastic, biological, immunological agents used for malignant oncology and hematology diagnoses) | Chemotherapy Policy and Procedure outlines requirements for independent double verification(IDV) of order, laboratory parameters, body surface area, medication, dose, route, frequency, etc. |
| Chemotherapy order form (or electronic equivalent) required |
| Only attending physicians with chemotherapy privileges may write orders |
| No verbal or telephone orders allowed (except to clarify as outlined in policy) |
| Only Chemo-verified RN’s may administer (exceptions are made for some oral agents, refer to the Chemotherapy Policy and Procedure for details) |
IV Electrolytes (i.e., potassium chloride and phosphate, concentrated sodium chloride, magnesium sulfate, calcium chloride, and calcium gluconate) | Independent double verification required (IDV not required for 1000 mL pre-mixed IV solutions) |
| No concentrated products outside Pharmacy (Rare exceptions exist, but only with specific safeguards) |
| Electrolyte policy provides specific administration parameters and limits |
| Electrolyte replacement protocol includes dosing and monitoring parameters |
| Standard concentrations/premixes |
Intravenous/subcutaneous anticoagulants (i.e., heparin, lepirudin, enoxaparin, argatroban, bivalirudin—excluding flushes) | Independent double verification required |
| Weight-based protocol for heparin. The prescriber must designate the specific protocol (e.g., Cardiac, Noncardiac) to be implemented |
| Duplication warning in Clinical Information System |
| Standardized order review requirements for enoxaparin and fondaparinux |
| Standardized laboratory assessments for heparin, enoxaparin, and fondaparinux for treatment of deep vein thrombosis/pulmonary embolism |
| Premixed heparin solutions in standard concentrations |
Neuromuscular blocking agents | IDV required |
| Availability limited to specific units and access limited on these units (e.g., emergency department, operating room, intensive care unit) |
| Special labeling of packages |
| Standard concentrations established |
Insulin | IDV required (Note: verification of the insulin product is not required when insulin is supplied directly from pharmacy in patient-specific units of use (e.g., prefilled syringes versus vials) |
| Floor stock limited to specific agents and Pharmacy removes unused patient-specific vials from patient care units daily |
| Resources include the Insulin Infusion Policy and the IV push insulin parameters defined within policy |
| Sliding scale order sets create a consistent process |
Anesthetic agents used outside the OR (e.g., propofol, ketamine, methohexital, etomidate, dexmedetomidine) | IDV required |
| Guidelines for use and administration of propofol |
| These agents have been added to the Moderate-Deep Sedation Policy with defined safeguards for use |
Warfarin | IDV required |
| Standard administration time to allow access to International Normalized Ratio (INR) results prior to daily dosing |
| Laboratory monitoring standards and standardized order review processes |
| Critical value—clinical laboratory calls with INR results >5 |
| Automated dispensing cabinet (ADC) inquiry—nurse is asked if he/she knows the patient’s current INR as warfarin is being taken from ADC for administration to the patient |
| Pharmacy monitoring of at-risk patients |