Patient Safety News

June 2022

New Requirement: Zero All Arterial Lines After Placement

  • If an arterial line is zeroed, and sits a long time prior to patient connection, it may not correlate accurately.
  • All arterial lines should be re-zeroed by providers when first connecting to patients.

Medfusion 4000 Syringe Pump Device Correction

Known Issues & Interventions

Changes to Syringe Pump Library/Anes > 10 kg

A syringe pump library update was made at the end of May. The “Anes > 10 kg” library will have changes in the infusion programs for propofol, sufentanil, remifentanil and fentanyl.

  • Recommendations for weight-based dosing of these medications are now included as drug alerts on the 2nd screen. Ideal body weight for remifentanil, sufentanil and fentanyl; Total body weight for propofol. You can review all of this in the educational materials developed by Dr. Quinn for AMR last December.

** A few things about weight-based dosing for afficionados: These recommendations are based on the pharmacokinetics of these medications given by infusion. Of course, it is up to each individual to dose their anesthetic, which can be viewed as pharmacodynamics. Ideal body weight calculations are simply based on the patient’s height, and it is expected that large difference between ideal and total body weight will make the pharmacokinetics more difficult. Finally, induction weight-based dosing is a separate topic. All of this is surprisingly complicated, but a daily challenge, so the team is diligently developing a presentation for grand rounds on this topic. **

  • Those who responded to our survey overwhelmingly wanted to shorten start-up, so these drug programs were written to move the following to the options menu: Loading dose & Bolus dose. All of the capabilities of the pumps are preserved. This leaves a 7 screen start-up with what were thought be the most common defaults. If you would like to set up a loading dose or bolus dose you will find these in the options menu.

Duplicate Order Entry for PACU Orders & Overriding Warnings

  • Please double check signed & held section of orders before placing orders.
  • There has been a recent increase in the number of times people have had duplicate orders.
    • This is a safety risk to patients.
    • It increases work for our nursing colleagues.

“Watch Meds” Functionality in Epic


Broadcast Anesthesia Help

  • Used to obtain rapid help for intraoperative events – unanticipated difficult airway, sudden massive blood loss, etc.
  • How to do it:
    • Press grey button on Vocera and say “Broadcast Anesthesia Help” (note it doesn’t say “call”)
      • Connects to everyone signed into the role.
      • Effectively turns devices into walkie talkies.
      • Initiator can talk freely.
      • Responders press and hold grey button to talk.
      • Initiator ends the conversation by pressing their grey button again.

Gas Machine Checks

REMINDER: If you arrive in the morning and find that your anesthesia machine has not been checked, please help our techs by performing the machine check yourself.

They are experiencing a staffing shortage, and often do not have enough time to check all of the machines by 0730.

If you require a refresher on how to perform the machine check please contact Dan Moyles (daniel_moyles@med.unc.edu).

Drug Shortages – June 2022

Metronidazole – National severe shortage

  • National severe shortage due to manufacturing supply issues.
  • For surgical prophylaxis, please use alternatives outlined below:
    • Patients undergoing intra-abdominal surgery or gynecologic surgery with colon involvement:
      • ▪ 1st line – Cefoxitin OR Ampicillin-Sulbactam (Unasyn)
      ▪ 2nd line – Levofloxacin AND Clindamycin
      ▪ 3rd line – Clindamycin AND Gentamicin
    • Patients undergoing gynecologic surgery without colon involvement:
      • ▪ 1st line – Cefazolin OR Ampicillin-Sulbactam (Unasyn)
      ▪ 2nd line – Levofloxacin AND Clindamycin
      OR Clindamycin AND Gentamicin

Local Anesthetics with Epinephrine

  • All local anesthetics with epinephrine remain on backorder.
  • Limited centralized supply may be available from OR Pharmacy Satellite.
  • Adequate supply of all plain local anesthetic vials for now.

Dextrose 50%

  • Please use D10W, 250 mL bags loaded in Pyxis.
  • Contain same amount of dextrose, 25 gm.

Atropine 1.2 mg/3 mL Syringes

  • Temporarily replaced with 0.4 mg/1 mL vials.
  • Same concentration, SMALLER volume.

Lidocaine 100 mg/5 mL syringes

  • Temporarily replaced with 100 mg/5 mL vials.
  • Same concentration, same volume.

Belzer UW Cold Storage Solution

  • Shortage resolving.

Esmolol 100 mg/10 mL Vials

  • Shortage resolving.

Drug Shortage information can also be found on the PSQI SharePoint site (available only when connected to the hospital’s secure network/wifi).

Questions or concerns? greg_balfanz@med.unc.edu
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UNC Department of Anesthesiology PSQI