ISMP survey on promethazine

ISMP is asking for your help in defining the scope of the problem and prioritizing strategies to avoid severe tissue damage when administering IV promethazine. Please complete the survey even if you no longer use promethazine in your facility. Submit your responses to ISMP by Sept 29, 2006. Thanks for you participation!

1). The following strategies were suggested in the newsletter to reduce the risk of severe tissue damage when administering IV promethazine. Please rate the value of each recommendation and note whether your facility follows the recommendation. Select Not Applicable for recommendations that do not apply because promethazine is not administered IV in your facility, or you do not use automated dispensing cabinets.

About your process

Recommendation	Value of recommendation 1=low_value...5=high_value	Does your facility follow the recommendation?	Comments
a) Limit the concentration in stock to 25 mg/mL	1 2 3 4 5	YesNo NA
b) Limit the starting dose to 6.25 to 12.5 mg IV	1 2 3 4 5	Yes No NA
c) Dilute the drug in 10 to 20 mL of normal saline	1 2 3 4 5	Yes No NA
d) Prepare the drug in minibags containing normal saline	1 2 3 4 5	Yes No NA
e) Do not allow administration via hand or wrist veins	1 2 3 4 5	Yes No NA
f) Give the drug through a central venous site only	1 2 3 4 5	Yes No NA
g) Inject the drug through a running IV line	1 2 3 4 5	YesNo NA
h) Inject the drug through a running IV line at the port furthest from the patient’s vein	1 2 3 4 5	YesNo NA
i) Administer the drug slowly over 10-15 minutes	1 2 3 4 5	YesNo NA
j) Require the person administering the drug to remain with the patient to assess the IV site during the entire injection/infusion	1 2 3 4 5	YesNo NA
k) Standing orders for promethazine IV reflect the current safety requirements	1 2 3 4 5	YesNo NA
l) Patients are advised to report burning or pain	1 2 3 4 5	YesNo NA
m) An alert appears on MARs reminding staff of safety precautions	1 2 3 4 5	YesNo NA
n) An alert appears on automated dispensing cabinet screens reminding staff of safety precautions	1 2 3 4 5	YesNo NA
o) Remove promethazine from the formulary	1 2 3 4 5	YesNo NA
p) Ban IV use of promethazine	1 2 3 4 5	YesNo NA
q) Use alternative rescue antiemetics Specify:	1 2 3 4 5	YesNo NA

2). At your current or past facility, have there been any cases of serious tissue damage in the past 5 years that occurred after IV administration of promethazine?	Yes No Not sure
3). Do you believe FDA should withdraw approval of the IV route of administration of promethazine?	Yes No Not sure
4). Please select what best describes your profession.
5). Please select what best describes your facility