documenting lot numbers

[susansew]

Is documentation of the lot numbers for irrigation required in the EMR?

[Rose_Queen, BSN, MSN, RN]

You would need to check your facility policy. If it is purely for irrigation, we do not document it. If, however, it is used in conjunction with an implant in any way (rinsing, reconstituting, etc), then yes, we document it.

[ORoxyO]

You would need to check your facility policy. If it is purely for irrigation, we do not document it. If, however, it is used in conjunction with an implant in any way (rinsing, reconstituting, etc), then yes, we document it.

Same here.

[Kooky Korky, BSN, RN]

A recent episode of "Something's Killing Me" was about people getting fungal meningitis after having spinal injections of a steroid that was contaminated with a fungus.

Fortunately, the source of the steroid could be traced because it was determined that all of the patients, who were in several US states and, I think, in Canada, had been treated at the same hospital. It was then traced back to the pharmacy at which the steroid had been manufactured. While I'm not sure the lot number of each vial was recorded in each patient's chart, that could have further helped to ID the culprit vials and pharmacy.

I say go ahead and chart the lot #. What could it hurt? And it could help.

[FurBabyMom, MSN, RN]

I have to agree with Rose Queen - we only document Lot numbers for irrigation solutions if used with implants - specifically for reconstitution, soaking, etc. This is a requirement for tissue (bovine, porcine, human) more than it is for non-permeable things like plates, screws, rods, etc. We don't "have" to document lot numbers for antibiotic irrigation solutions for, say, a spine case. Can we - sure. Have to - no. If the surgeons put any antibiotic powder in the wound while closing - yes, that lot number should be documented on that same spine case (difference being the antibiotic powder remains until absorbed by the body).

Personally, if I know we "might" use a tissue graft that might need soaked, I document the lot numbers of the solution as I go, rather than try to capture it at the end of the case (ex - all of my NaCl going in the warmer - the lot numbers get charted on our MAR in my entries). With respect to Lot numbers and implants - our facility requires we document solutions and lot numbers with the implant documentation - one "screen" is the administration, one is the use relative to an implant.

[FurBabyMom, MSN, RN]

A recent episode of "Something's Killing Me" was about people getting fungal meningitis after having spinal injections of a steroid that was contaminated with a fungus.

Fortunately, the source of the steroid could be traced because it was determined that all of the patients, who were in several US states and, I think, in Canada, had been treated at the same hospital. It was then traced back to the pharmacy at which the steroid had been manufactured. While I'm not sure the lot number of each vial was recorded in each patient's chart, that could have further helped to ID the culprit vials and pharmacy.

I say go ahead and chart the lot #. What could it hurt? And it could help.

For what it's worth - unless my memory fails me - there were a myriad of issues with the way the medication in question and the compounding pharmacy in question managed their practice. If I recall, the pharmacy did not meet regulatory (state?) criteria to operate as a compounding facility and there were serious HVAC system deficiencies which allowed mold to exist in the enviornment to begin with.

If this is the argument - then we should be recording lot numbers for all medication administration, not specific to a procedure or operation. The fungus could have just as easily caused a blood stream infection (albeit easier to treat than CNS fungal infections - but perhaps potentially equally difficult to treat in an immunosuppressed patient). Based on the same argument, one could expand the "lot number required" documentation to all supplies used...and I do not have the time in the day to document lot numbers on 50+ pairs of gloves in a multi team all day case.