From: David Collette
To: grp allpharm
Sent: Friday, March 23, 2018 2:04:11 PM
Subject: KCL IVPB issues

Becky sent the following info out regarding the KCL 40 mEq/100mL IVPB shortage:

KCL 40 mEq/100 mL IVPB is critically short. This afternoon, iCare changes will go into effect that prompt the nurse to remove 2 of the KCl 20 mEq/100 mL IVPBs for a 40 mEq dose! Of course this will provide twice the fluid volume of the KCl 40 mEq/100 mL piggyback. For that reason, there will be an option for patients who are severely fluid restricted to receive a 40 mEq/100 mL piggyback. Access to enter the order for the 40 mEq/100 mL piggyback will be located under "Electrolytes" in the "NSS Meds" section of the NSS/PKS button in iCare. A label will print for dispensing (will print in PSP at Main) if the 40 mEq/100 mL commercial product is not loaded in that Pyxis machine.

I have already sent an email to nursing leaders that they will need to work with their pharmacist to get a 40 mEq/100 mL KCL piggyback for their severely fluid restricted patients. If you know in advance that the patient is severely fluid restricted, go ahead and change the order to the more concentrated KCL. However, we are not placing sole responsibility for picking the appropriate volume on the pharmacist...nursing has been instructed to work with their pharmacist to make sure the 100 mL bag is entered when absolutely needed. You may see some orders for NO SUB on the 100 mL bag on some units, but we generally expect nursing to contact their pharmacist when the more concentrated bag is needed.

Thanks again for helping us survive yet another shortage and continue to provide the best possible care for our patients. Have a great weekend! DAVID

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David R. Collette, Pharm.D., FASHP
Operations Manager, Professional Services