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An IVIG stewardship program, including an institution-specific prescribing guideline and a pharmacist-driven stewardship program, may ensure guideline compliance for appropriateness of indication and dose at an academic medical center.

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Background: Etomidate is the standard induction agent used during rapid sequence intubation (RSI) in the emergency department (ED). Etomidate shortages require providers to utilize alternative agents. The purpose of this study is to compare the safety and procedural outcomes of propofol and etomidate for RSI in the ED. Methods: This was a retrospective chart review of adult patients in the ED who received propofol or etomidate for induction during RSI. The main endpoint was hypotension, defined as a systolic blood pressure < 90 mmHg or diastolic blood pressure < 60 mmHg, within the first hour of intubation. Time to intubation, intensive care unit length of stay, hospital length of stay, and in-hospital mortality were also evaluated. Results: Two hundred and seventy five patient charts were reviewed. Of the 98 patients included, 43 patients received propofol and 55 patients received etomidate. Propofol was associated with an increased incidence of hypotension within the first hour of intubation (65.1% vs. 25.5%, p < 0.001). No difference was found in the time to intubation: ≤5 minutes (51.2% vs. 34.6%, p = 0.83). The mortality rate was 11.6% in the propofol group and 27.3% in the etomidate group (p = 0.004). There was no difference in hospital or intensive care unit length of stay between the propofol and etomidate groups (7.7 vs. 9.2 days, p = 0.23; 4.2 vs. 6.3 days, p = 0.31). Conclusion: Propofol was a safe and procedurally effective induction agent for RSI. Compared to etomidate, it was associated with an increased rate of hypotension within the first hour of intubation, with no difference in the percent of patients that required an intervention.

BackgroundRegular human insulin 100 units added to a sufficient quantity of 0.9% sodium chloride, to yield a total volume of 100 mL within a polyvinylchloride bag, is accepted to be stable for 24 hours due to physical denaturation and chemical modification. The objective of this study was to evaluate the extended stability of such extemporaneously prepared regular human insulin, stored under refrigeration, to the maximum beyond-use-date allowed by United States Pharmacopeia chapter 797.MethodsAt time “0” three admixtures of regular human insulin were prepared by withdrawing 1 mL of regular human insulin with a concentration of 100 units/mL and adding it to a sufficient quantity of 0.9% sodium chloride for injection in a polyvinylchloride bag to yield a total volume of 100 mL. The three admixtures were stored under refrigeration (2°C–8°C [36°F–46°F]), and one sample of each admixture was withdrawn and tested in duplicate at 0, 6, 24, 48, 72, 144, 168, 192, 216, 240, 312, and 336 hours. Utilizing high performance liquid chromatography, each sample underwent immediate testing. The time points were stable if the mean concentration of the samples exceeded 90% of the equilibrium concentration at 6 hours.ResultsThe equilibrium concentration was 0.89 units/mL. Time points were stable if the mean concentration was at least 0.80 units/mL. All time points retained at least 90% of the equilibrium concentration, with the exception of hour 168 (0.79 ± 0.03 units/mL). At 192 hours the mean concentration was 0.88 ± 0.03 units/mL. At 336 hours the mean concentration was 0.91 ± 0.02 units/mL.ConclusionBased on these results, regular human insulin 100 units added to 0.9% sodium chloride for injection in a polyvinylchloride bag to yield a total volume of 100 mL is stable for up to 336 hours when stored at 2°C–8°C (36°F–46°F).

The role of a pharmacist is unique and can most effectively triage drug information and medication distribution, especially during times of high demand and high stress.