Dual Signatures Required for High-Risk Medication Rate Changes

For All Inpatient Nurses
Dual Signatures Required for High-Risk Medication Rate Changes

As a reminder, dual signatures are required for rate changes on select high-risk IV medications and dosage levels to ensure patient safety. This is for administration of drug therapies, regardless of pump integration.

Epic will prompt a dual signature before accepting the change (see screenshot below) when a rate change for identified medications is entered.

Identified medications include:

  • Anticoagulants, IV: argatroban, bivalirudin, heparin

  • Antithrombotic agents: alteplase (except for catheter clearance)

  • Benzodiazepines, IV: lorazepam, midazolam

  • Concentrated electrolytes: magnesium doses of 4 grams or more

  • Epidural and PCA pain management: fentanyl, HYDROmorPHONE, morphine

  • HYPERtonic solutions: sodium chloride with concentrations greater than 0.9%

  • Neuromuscular blocking agents infusions: cisatracurium, nimbex, rocuronium

  • Prostacyclin, IV: epoprostenol (Flolan®) / (Veletri®); treprostinil (Remodulin®)

For more information, please refer to High Risk Medication guidelines in Policy Tech.

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