EMERGENCY USE AUTHORIZATION
Double-strength propofol now available
The FDA has granted Fresenius Kabi an Emergency Use Authorization to allow importation of Fresenius Propoven 2% (propofol 20 mg per mL) emulsion in 100 mL vials. The number of patients with COVID-19 requiring mechanical ventilation has created propofol shortages worldwide. Propoven 2% emulsion, which is not FDA-approved for use in the US, provides sedation via continuous infusion in patients over age 16 who require mechanical ventilation in an ICU. It contains the same active ingredient, propofol, as Fresenius Kabi's FDA-approved Diprivan Injectable Emulsion USP 10 mg/mL, but with double the concentration.
The company is providing key information about how Propoven 2% differs from Diprivan 1%, along with additional materials, such as alert stickers to place on vials; wall charts to display in key areas such as pharmacies, ICUs, and EDs; and healthcare provider and caregiver fact sheets (see http://www.ismp.org/ext/502). As shown below, the stickers read, "Caution: DOUBLE Strength Propofol. 2,000 mg per 100 mL." Although the product is meant for ICU patients only, anesthesia and ED personnel outside the ICU also need to be aware of its availability to prevent mix-ups.
THE KIDs LIST
Creating a standard for pediatric patients
To create a standard of care for the safe use of medications in pediatric patients, the Pediatric Pharmacy Association commissioned a group of pediatric pharmacists to evaluate the literature and compile a list of potentially inappropriate drugs for pediatric patients. Called the KIDs List, it is the first listing of drugs that should be either avoided or used with caution in all or a subset of pediatric patients. It is akin to the well-known Beers Criteria used for older adults. The Institute for Safe Medication Practices served as a reviewer for the project, which was published in March.1 Review the full article at http://www.ismp.org/ext/459.
REFERENCE
1. Meyers RS, Thackray J, Matson KL, et al Key potentially inappropriate drugs in pediatrics: the KIDs list. J Pediatr Pharmacol Ther. 2020;25(3):175-191. [Context Link]
LIDOCAINE
Right drug, wrong indication
An ED physician prescribed I.V. lidocaine to manage pain in a trauma patient awaiting an inpatient bed. In the ED, the multimodal order set for pain management called for lidocaine 800 mg in 200 mL of I.V. fluid (4 mg per mL) to be administered over 4 hours at a dose of 200 mg (50 mL) per hour. However, instead of the pain management dose for lidocaine, the prescriber mistakenly ordered a 2 g lidocaine bag, which is used to treat cardiac dysrhythmias. The patient's nurse, who was expecting a bag of lidocaine to treat pain, called the pharmacy to verify the order and request the medication. The pharmacist verified the cardiac lidocaine order and sent a bag of lidocaine 2 g in 500 mL of 5% dextrose (lidocaine 4 mg per mL). The nurse administered this lidocaine based on the multimodal pain order set (200 mg or 50 mL per hour) for 3 hours. A pharmacist who was present in the ED recognized the lidocaine 2 g bag, realized the error, and intervened.
Because the lidocaine concentration was the same for both indications and the administration rate was set correctly at 200 mg/hour, the patient did not receive an overdose. However, had the nurse programmed the infusion pump to deliver the full volume to be infused (500 mL), the patient would have received a 2 g dose, not the prescribed 800 mg dose.
To reduce confusion when selecting these drugs from computer screens, the hospital has now added **for CARDIAC use only** to the description for lidocaine 2 g per 500 mL. Because lidocaine is increasingly prescribed to manage pain, organizations should ensure they have applicable order sets and appropriate settings in the smart pump library.