![]() Dose limit alerts are configured as a "hard stop," requiring pump to be reprogrammed if dose exceeds limits.Dose limit alerts are operational at all times.Separate dose limits can be set for bolus doses and maintenance doses.Pump includes a bolus dose feature that allows programming to automatically switch to the continuous infusion rate at the end of the bolus AND staff are trained to use this feature.Administering the bolus from the maintenance infusion using a "smart" infusion pump that has the following safety features: 10.Use of the maintenance infusion to administer a bolus manually is a high-risk practice that should be avoided. Establish the unit’s standard approach for administering a loading dose (bolus).Limit the number of different kinds of infusion pumps to maximize staff familiarity with infusion equipment.Standardize magnesium sulfate dosing using a calibrated infusion pump with free-flow protection. ![]() Pharmacy and nursing staff should use a consistent approach to labeling all magnesium sulfate bags and tubing used to administer the medication.Medication errors are more common in unit-prepared bags, so this practice should be avoided.Unit-established process for using manufacturer’s premixed bags or pharmacy-prepared bags of magnesium sulfate for both loading dose (bolus) and maintenance infusion.Use uniform and standard drug packaging, preparation, and labeling. Staff with requisite training and supplies available to respond to magnesium-related adverse events, for example respiratory depression.In addition, the FDA and professional organizations offer warnings against use of magnesium sulfate longer than 5 to 7 days because of risk of fetal and neonatal bone demineralization and fractures.Contraindications on the manufacturer’s drug label include 8. Absence of contraindications for magnesium sulfate are verified and documented.Several professional organizations, guidelines, and evidence reviews offer examples of maternal and fetal conditions that may be indications for use of magnesium sulfate. Criteria for use of magnesium sulfate are established.Standard criteria established for magnesium sulfate use. Key Perinatal Safety Elements Standardize When Possible (CUSP Science of Safety) A sample of how some of these key perinatal safety elements can be incorporated into a unit approach to safe magnesium sulfate administration is provided in the Appendix of this tool. Consider using preprinted orders, standing orders, and staff training to support implementation. Consider any existing facility policies or processes related to magnesium sulfate use. How to use this tool: Review the key perinatal safety elements with L&D leadership and unit staff to determine how the elements will be implemented on your L&D unit. Who should use this tool: Nurses, physicians, midwives, pharmacists, and other labor and delivery (L&D) unit staff responsible for the preparation and administration of magnesium sulfate during labor. The key elements are presented within the framework of the Comprehensive Unit-based Safety Program (CUSP). Purpose of the tool: This tool describes the key perinatal safety elements with examples for the safe administration of magnesium sulfate during labor.
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