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The COVID-19 pandemic has stretched hospitals to capacity with highly contagious patients. Acute care hospitals around the world have needed to develop ways to conserve dwindling supplies of personal protective equipment (PPE) while front-line clinicians struggle to reduce risk of exposure. By placing intravenous smart pumps (IVSP) outside patient rooms, nurses can more quickly attend to alarms, rate adjustments and bag changes with reduced personal risk and without the delay of donning necessary PPE to enter the room. The lengthy tubing required to place IVSP outside of patient rooms comes with important clinical implications which increase the risk to patient safety for the already error-prone intravenous medication administration process. This article focuses on the implications of increasing medication dead volume as intravenous tubing lengths increase. The use of extended intravenous tubing will lead to higher medication volumes held in the tubing which comes with significant safety implications related to unintended alterations in drug delivery. Safe intravenous medication administration is a collaborative responsibility across the team of nurses, pharmacists and ordering providers. This article discusses the importance and safety implications for each role when dead volume is increased due to IVSP placement outside of patient rooms during the COVID-19 pandemic.

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Heparin is widely used in a variety of settings for prevention and treatment of thromboembolic events. Data from a number of sources indicate that it is also one of the drugs most frequently associated with adverse events and medication errors, many of which are serious. National media attention has focused on recent events involving heparin and The Joint Commission has included heparin in its 2009 National Patient Safety Goal to reduce patient harm from anticoagulants. Heparin safety is on the national agenda and health care organizations are struggling to improve it. Health care providers in clinical, management, and executive roles must work together to improve heparin safety. Over 40 anticoagulation experts and practitioners came together in San Diego on March 13 through 14, 2008 to share information, offer perspectives, and address issues on the topic improving heparin safety. These individuals represented The Joint Commission, United States Pharmacopoeia, the Institute for Safe Medical Practices, academic institutions, large health care systems, and small hospitals who participated in a day and a half of presentations and round-table discussions. This article summarizes 21 presentations with a primary focus on types and frequency of heparin errors as well as identified opportunities to improve heparin safety. The conference was sponsored by Cardinal Health's Center for Safety and Clinical Excellence.

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