We report one of the first cases of probable rivaroxaban-induced rash, whereas the patient tolerated apixaban. Further investigation is warranted, but prescribers should be cognizant of this potential issue when choosing a factor Xa inhibitor for anticoagulation.

Implementing interdisciplinary psycho-pharmacology rounds in a nursing facility resulted in a reduction of inappropriate antipsychotic use and improved monitoring and documentation.

Purpose: To report the presentation, management, and potential future avoidance of vancomycin extravasation. Summary: An 84-year-old woman was admitted to the emergency department due to observed seizures that progressed to status epilepticus. Status epilepticus was controlled, but the patient developed hospital-acquired pneumonia, requiring treatment with vancomycin and cefepime. During treatment with vancomycin, extravasation occurred during peripheral administration. Cold packs were immediately applied to the lesion for the next 24 hours with common gauze open dressings with frequent changes, and silver sulfadiazine 1% topical application once daily were started on the day after extravasation. While skin necrosis developed, it did not require surgical intervention and common gauze open dressings with frequent changes and silver sulfadiazine 1% topically were continued until the wound was healed. Conclusion: Although the package insert warns of extravasation with potential necrosis during vancomycin administration, this case highlights a potentially under-reported adverse event. Vancomycin extravasation was successfully managed by utilizing cold compress for the first 24 hours post-extravasation with common gauze open dressings and silver sulfadiazine 1% until the wound was healed. With a potential for vancomycin extravasation when administered peripherally, we would recommend central venous administration.