Replying with topics from our most recent Pediatrics Networking Session! Hopefully they serve you and your centers, even if not seen often.

1. Safe Dispensing of Subcutaneous Meds

-Neupogen as example, did use insulin syringes

-Safety aspect to not using

-Use of overfill, but then need to mark clearly on instructions

-Neupogen, lovenox, epogen, cytarabine

2. Ampicillin dosing

-Jess D shared variance in practice (some providers 50 mg/kg, some 100 mg/kg, different intervals (q12h vs q8h)

-Sanford practice:

GA 34w0d or less and 0-7 days old: amp 50 mg/kg every 12 hours

GA 34w0d or less and 8-28 days old: amp 75 mg/kg every 12 hours

GA greater than 34w0d: 50 mg/kg every 8 hours

ANY GA or PMA MENINGITIS / Meningitis rule out: 100 mg/kg every 8 hours

-Essentia is doing 100 mg/mL concentration for all doses (immediate use) but in IV room, not bedside

-Sanford IV room compounds 30 mg/mL for all patients in IV room

3. 36 vs 48 hour NICU sepsis rule out

-Essentia doing provider discretion, nothing standardized - 48 hours mostly

-Fargo has a provider that is trying to change practice to 36 hours as standard, more to come

4. Standardized Drip Concentrations / Other Meds

-Essentia has worked through adult infusions, now about ~halfway through peds drips

-Fargo also working through same process slowly, in conjunction with other Sanford sites

-Kaylee shared electrolyte concentrations and build for supplementation

5. KIDS List

-Fargo recently implemented order instructions for order entry for the medications, language

-Essentia evaluating for future

6. TPN + Heparin

-Central line in NICU, Fargo is working through how much to add, and if even needed? Should it be based on RATE of TPN?? If added, should it be limited by units/mL vs units/kg/hr?

-Two bigger children's hospitals use NO heparin in any flow rate 5 mL/hr or greater, needing to ensure not splitting that rate if this is adopted (example: bifurcated lines)

-Essentia shared usually on the 0.25 units/mL dose, and often not meeting the 5 unit/kg/hr (Jess uses this as her personal 'maximum')

-Jess shared that their starter TPNs come standard with heparin and calcium, which has been an additional challenge

7. Electrolytes

-Jess shared typical practice for electrolyte replacements, their orders may be older and more concentrated

-Evaluating safe concentrations / newer literature (example of calcium 100 mg/mL -> 50 mg/mL)