Unforeseen Dangers: Drugs That Are Hazardous to Health Care Personnel.

Antineoplastic and other hazardous drugs present a risk to health care personnel if they are not contained by appropriate facility design, personal protective equipment, and work practices that support safety. These drugs pose the risk of carcinogenicity and reproductive risks to personnel, which can be mitigated by using the proper containment practices.

Enhancing insulin-use safety in hospitals: Practical recommendations from an ASHP Foundation expert consensus panel.

PURPOSE: Consensus recommendations to help ensure safe insulin use in hospitalized patients are presented. SUMMARY: Insulin products are frequently involved in medication errors in hospitals, and insulin is classified as a high-alert medication when used in inpatient settings. In an initiative to promote safer insulin use, the American Society of Health-System Pharmacists (ASHP) Research and Education Foundation convened a 21-member panel representing the fields of pharmacy, medicine, and nursing and consumer advocacy groups for a three-stage consensus-building initiative. The panel's consensus recommendations include the following: development of protocol-driven insulin order sets, elimination of the routine use of correction/sliding-scale insulin doses for management of hyperglycemia, restrictions on the types of insulin products stored in patient care areas, and policies to restrict the preparation of insulin bolus doses and i.v. infusions to the pharmacy department. In addition, the panelists recommended that hospitals better coordinate insulin use with meal intake and glucose testing, prospectively monitor the coordination of insulin delivery and rates of hypoglycemia and hyperglycemia, and provide standardized education and competency assessment for all hospital-based health care professionals responsible for insulin use. CONCLUSION: A 21-member expert panel convened by the ASHP Foundation identified 10 recommendations for enhancing insulin-use safety across the medication-use process in hospitals. Professional organizations, accrediting bodies, and consumer groups can play a critical role in the translation of these recommendations into practice. Rigorous research studies and program evaluations are needed to study the impact of implementation of these recommendations.

Nursing best practices using automated dispensing cabinets: nurses' key role in improving medication safety.

Automated dispensing cabinets (ADCs) are used widely, but safety gaps remain. Nursing-pharmacy collaboration, expert guidance, self-assessment tools, compliance with nursing best practices, and continuing education are essential to optimize the safety and productivity of ADC use.