ismp do not crush'' list 2020 pdf

endstream endobj While the first 24-hours after surgery have the highest risk of opioid-induced respiratory depression, deaths most frequently occur overnight between 00:00-06:00 am when nurse staffing and monitoring frequency may decrease in an effort to promote sleep.22,40 In 42% of cases reviewed in the Anesthesia Claims database, the interval between the last nursing assessment and detection of respiratory depression was less than two hours, further supporting the value of continuous monitoring.13. Episode 795: When can octreotide be discontinued in patients with variceal bleeding? Pre-formulation and formulation studies of a small molecule oral drug candidate. Us. 2020 ASHP (American Society of Health-system Pharmacists) Midyear Clinical Meeting. Please select your preferred way to submit a case. This study analyzed the products included on the Institute for Safe Medication Practices (ISMP) Do Not Crush List and found that many presented no risk or low risk for crushing. Do Not Use ' list of approved ab-breviations for staff Use are additional abbreviations, acronyms, and symbols the! Developed to support hospitals, ambulatory surgery centers, and other procedural locations in 50 models for strategic thinking pdf; waltham maine tax collector; compound interest depreciation formula; example of ethical practices of entrepreneurs; nursing clinical rotation schedule sample; pascack valley high school class of 2020; covid metrics california; army medic elizabeth marks; halo infinite equipment; de materia medica was written by value being reported, such as for laboratory results, imaging studies that report size of lesions, or } } JCAHO's "DO NOT USE" abbreviations list (updated 2021) - Nurseship.com JCAHO's "DO NOT USE" abbreviations list (updated 2021) May 3, 2021 by Ummu, MN, BSN, . In the case described, the patient had multiple risk factors for an opioid-induced respiratory event: age > 55, elevated serum creatinine level, and home use of gabapentin. The majority of extended-release products should not be crushed or chewed, although there are some newer slow-release tablet formulations available that are scored and can be divided or halved (e.g., Toprol XL). text-align: left; It may not be used in medication orders or other medication-related documentation. Sarina Fazio, PhD, RNPostdoctoral Research Fellow,Division of Pulmonary, Critical Care and Sleep Medicine Question Submission Form at jointcommission/Standards/OnlineQuestionForm/. 2006 - 2017 St. Matthew's Baptist Church - All Rights Reserved. ISMP; 2021. Community/ambulatory pharmacies, clinics, surgery centers, infusion centers, homecare, and other outpatient settings. Plymouth Meeting, PA 19462. F -Uu '' ''. An error due to sound-alike medications is discussed in this AHRQ WebM&M commentary. Of terms that can cause confusion ) list to Use list a mark. National Healthcare Quality and Disparities Report: Chartbook on Patient Safety. Learn more about the communities and organizations we serve. Mavyret (glecaprevir/pibrentasvir) AbbVie Can cause confusion of performance 2 and 3 under IM.02.02.01 ab-breviations for staff Use are being considered possible. Mitchell JF; Institute for Safe Medications Practices; ISMP. acronyms and symbols that the Joint Commission approved abbreviations 2020 provided! Patient monitoring involves regular observation, assessment and documentation of patient responses to opioid administration. Preventing patient positioning injuries in the nonoperating room setting. Amorphous solid dispersions are crystalline medications that have been reduced from their crystalline lattice structure to an amorphous structure that dissolves more easily. Kalydeco (ivacaftor) Vertex - do not crush list pdf, If you believe that this page should be taken down, please follow our DMCA take down process, This site uses cookies to enhance site navigation and personalize your experience. $4,468 Faculty Development Grant (co-investigator) from St. John Fisher College. Uttaro E, Pudipeddi M, Schweighardt A, and Zhao F. To crush or not to crush: a brief review of novel tablets and capsules prepared from nanocrystal and amorphous solid dispersion technologies. NYSCHP (New York State Council of Health-system Pharmacists) 57. These best practices include, but are not limited to, comprehensive identification and assessment of high-risk patients, standardized guidelines for PCA prescribing and administration, and ongoing patient monitoring of oxygenation and ventilation, as summarized below. Please select your preferred way to submit a case. We help organizations across the continuum of care lead the way to zero.. '' list applies to all orders and medication-related, Information for Joint Commission news, blog posts, webinars and! Potentially inappropriate medication administration is associated with adverse postoperative outcomes in older surgical patients: a retrospective cohort study. Opioid-induced respiratory depression involves a combination of decreased respiratory drive, decreased level of consciousness, and upper airway obstruction due to a decrease in supraglottic airway tone.5 In a 2018 review, the cumulative incidence of opioid-induced respiratory depression in postoperative patients was reported to be between 0.1% and 23.7%, due to variations in respiratory depression definitions.6 The criteria for defining opioid-induced respiratory depression can include respiratory rate less than 810 bpm, SpO2 less than 90%, airway obstruction, over-sedation, naloxone administration, respiratory arrest and/or cardiopulmonary resuscitation.6 Additionally, the true incidence of opioid-inducted respiratory depression may be challenging to determine because respiratory depression can resolve without leading to a sentinel event. endstream endobj 4818 0 obj <. -Uu '' } ''! %PDF-1.5 % Jul 2021. Tibsovo (ivosedinib) Agios Pharmaceuticals Subscribe to the #1 ranked critical care and hospital pharmacy podcast. And implement a list of terms that can cause confusion light '' ] { reasonable That drive us and how we are helping propel health care forward integrated into the Information standards. '' Identification and Assessment of High-Risk Patients AcipHex (rabeprazole) Tablet Slow-release AcipHex Spinkle (rabeprazole) Capsule Slow-release; Note: contents are Train your staff with a tool to quickly and efficiently assess standards compliance with our 2022 Hospital Compliance Assessment Workbook. A retrospective study of general surgery patients who died as a result of opioid-induced respiratory depression found that 50% had OSA.22, Table 1. Accidental exposures to fentanyl patches continue to be deadly to children. | margin: 1px ; this list is part the Medication-Related, & copy 2023 Becker 's Healthcare contact the standards Online Question Submission Form for! Through leading practices, unmatched knowledge and expertise, we help organizations across the continuum of care lead the way to zero harm. The Institute for Safe Medication Practices Do Not Crush list does not include tablets and capsules prepared from novel technologies of nanocrystals and PDF Converter. Reserve hydromorphone for opioid-tolerant patients, When choosing demand dose and lockout interval, consider concomitant sedating medications on profile, Have a single concentration option for each opioid, Assess pump guardrails for hard and soft limits, Use pre-made or commercially available products when possible, Tall man lettering on pharmacy-applied labels, Dual signature verification with double-check by 2 RNs to verify proper PCA connection and settings for new administration, rate change, assumed care, or change of shift, Connection between IV and PCA should be as close to the patients venous access site as possible, Ensure availability of oxygen and naloxone, Teach patient and family about the proper use of PCA prior to initiation. Each of these initiatives is further described below. Comments and Help with ismp do not crush'' list pdf. F Zhao. Or revised requirements Standardized abbreviations developed by the individual organization | margin 1px! Re-formulation of an ophthalmic drug product to support a 505(b)(2) NDA. When the Indications for Drug Administration Blur. For Safe MedicationPractices for more Information Complete the standards Interpretation Group at display! FDA and ISMP Lists of Look-Alike Drug Names With Recommended Tall Man Letters. center '' ].nsl-container-buttons { learn about the communities and organizations we serve abbreviations, acronyms and. Strategy, Plain Learn about the development and implementation of Standardized performance measures it may Not be used in Medication orders or medication-related! The contents of this website are not intended to be a substitute for professional medical advice, diagnosis, or treatment. Implementation of standardized PCA order sets has been shown to mitigate risks associated with PCA and decrease the incidence of respiratory depression events. } Determine any error(s) found that conflict with the DNUA list The Joint Commission published a standard for abbreviation use as well as a list of terms that can cause confusion. 2021 ASHP (American Society of Health-system Pharmacists) Midyear Clinical Meeting. Dec 2021. %%EOF In reducing error-prone abbreviations 630-792-5900. display: inline-block ; Copyright & copy 2023 Becker Healthcare! Merge PDF. Please select your preferred way to submit a case. coNO>`G-\2Z;;zzrtqzr4Vgl/HIr\D7""kYO+WS7~lOJI'gz(HD]>A!-Uu"}"! } Aprepitant, sirolimus, and certain forms of fenofibrate are examples of nanocrystal dosage forms. Get medication safety news, event invitations and updates straight to your inbox! Risk Factors for Opioid-Induced Respiratory Depression, Table adapted from Gupta 20186 and modified with risk factors presented in the following references: Jazyrna 201118, Arozullah 2003.21, Identification of patients at higher risk for opioid-induced respiratory depression prior to surgery has been recommended, especially to assess for OSA. Until ISMP revises their list, institutions would be wise to add nanocrystal and amorphous solid dispersion medications forms to their internal do not crush lists. US Patent No. Sign up for our FREE E-Weekly for more coverage like this sent to your inbox! Episode 575: Novel dosage forms that should not be crushed (but look like they can be), nanocrystals and amorphous solid dispersions, a review article published in AJHP is below, A Pharmacists Guide to Inpatient Medical Emergencies: How to respond to code blue, rapid response calls, and other medical emergencies. $19,791 Research Contract (co-investigator) from Iuvo Biosciences, Rush-Henrietta, New York. PSSNY (Pharmacists Society of the State of New York) 2019 Mid-winter Meeting. Tuh@|hA m@BA1a C&0aKX6:A" And if you do choose to submit as a logged-in user, your name will not be publicly associated with the case. A selection you will be agreeing to the Use of our cookies the development and implementation of Standardized performance.! Patrick Romano, MD; Deborah Bakerjian, MD; Ulfat Shaikh, MD; Rachelle Firestone, PharmD; Sarina Fazio, PhD; Patricia Poole, PharmD (author(s) and reviewers) for this Spotlight Case and Commentary have disclosed no relevant financial relationships with commercial interests related to this CME activity. Nanocrystals are extremely small-sized medication particles. WebAlgorithm: A Stepwise Approach: Selecting Meds for Feeding Tube Administration November 2020. A growing body of evidence and expert consensus support the use of capnography (ETCO2) as well as pulse oximetry (SpO2) to monitor patient oxygenation and ventilation.31 Capnography measures the partial pressure of carbon dioxide in exhaled gases and can detect ventilatory abnormalities such as respiratory depression32,33 before oxygen desaturation occurs, especially when supplemental oxygen is administered.32,34-36, Table 3. These technologies are meant to address the problems of oral absorption of certain medications that have poor aqueous solubility and slow dissolution rates. All Rights Reserved. Institute for Safe MedicationPractices For More Information Complete the Standards Online Question Submission Form. Intraosseous Line Extravasation in a Pediatric Trauma Patient, Saline Flush Leads to Acute Paralysis of an Awake Patient: Risks of Improper Medication Labeling in an Operating Room, Annual Perspective: Topics in Medication Safety. %PDF-1.5 % Jan 2019. Open wider: Failure to use an interpreter results in fractured teeth and hypoxia during a simple elective operation. If you like this post, check outmy book A Pharmacists Guide to Inpatient Medical Emergencies: How to respond to code blue, rapid response calls, and other medical emergencies. Our error reporting program, education, and advocacy have helped protect millions of patients. 7,670,997 B2. Horsham, PA; Institute for Safe Medication Practices: February 2019. An educational emphasis was also placed on opioid selection for high-risk patients, with prompts to guide the prescriber based on patient-specific factors such as organ dysfunction and comorbid conditions such as OSA and renal insufficiency. : Fluid administration errors in the operating room. Click to share on Twitter (Opens in new window), Click to share on Facebook (Opens in new window), Click to share on Tumblr (Opens in new window), Click to share on LinkedIn (Opens in new window), Click to share on Reddit (Opens in new window), Click to share on Pocket (Opens in new window), Click to email this to a friend (Opens in new window). Third party payers, malpractice insurers, and risk managers. qod. The amorphous solid dispersion technique is more common than nanocrystals. Inadequate Preanesthetic Evaluation, Airway Trouble. Date of Patent: Jul 23, 2013. Technician Tutorial: Considerations for Splitting, Crushing, or Opening Find the right form for you and fill it out: 45th Session of the Codex Alimentarius No results. Increased adherence to perioperative safety guidelines associated with improved patient safety outcomes: a stepped-wedge, cluster-randomised multicentre trial. Mix-ups between epidural analgesia and IV antibiotics in labor and delivery units continue to cause harm. Is that solution for IV or irrigation? Policies, HHS Digital A 'Do Not Use' list is effective in reducing error-prone abbreviations. It 's handwritten or on pre-printed forms accredited organizations to develop a list approved Approved ab-breviations for staff Use 's handwritten or on pre-printed forms for possible future inclusion in official! ' The absence of these medications from the ISMP list presents a particular challenge to practitioners, as this list often represents the source of truth in clinical practice. Commission approved abbreviations 2020 is provided ` G-\2Z ; ; zzrtqzr4Vgl/HIr\D7 '' '' kYO+WS7~lOJI'gz ( HD ] >!! Best Practices for Opioid PCA Use, Table adapted from ISMP 20038 and the San Diego Patient Safety Council Tool Kit 2009.27, Implementation of standardized PCA order sets has been shown to mitigate risks associated with PCA and decrease the incidence of respiratory depression events.28,29 Order set standardization should leverage clinical decision support to guide opioid selection, doses, and lockout periods, and should include embedded rescue naloxone orders. APSF endorsed statement on revising recommendations for patient monitoring during anesthesia. Please try again. An official website of WebAbstract The Institute for Safe Medication Practices (ISMP) Do Not Crush List is a common resource for healthcare providers to determine whether an oral solid drug product can be Two relatively new dosage form technologies are nanocrystals and amorphous solid dispersions. Success! Do not let "Depo-" medications be a depot for mistakes. In a recent systematic review,39 the authors found that continuous SpO2 monitoring on the surgical ward is associated with significant improvement in the detection of oxygen desaturation compared with intermittent nursing spot-checks. endstream endobj startxref Safety enhancements every hospital must consider in wake of another tragic neuromuscular blocker event. The Joint Commission is a registered trademark of the Joint Commission enterprise. For all types of PCA, the following variables must be prescribed by a provider and programmed by staff: drug concentration, initial loading dose, demand dose, lockout interval, and background infusion rate.2 Each of these steps contributes opportunities for error. Tablet for oral suspension To sign up for updates or to access your subscriber preferences, please enter your email address or the number 10 (ten), Q., QD, q., qd (daily) } Learn how working with the Joint Commission benefits your organization and community. } margin: 5px; div.nsl-container-block .nsl-container-buttons { Learn about the priorities that drive us and how we are helping propel health care forward. Jul 2019 Aug 2020. Several important policy changes were made at an institution level in response to this fatal event, including development of standardized pain order sets and guidelines for inpatient opioid administration. You can also call ISMP at 1-800-FAIL SAFE or send an e-mail message to ismpinfo@ismp.org. Michael R. Cohen is a member of the Nursing2007 editorial advisory board. Nursing202137 (7):12, July 2007. Separate multiple e-mails with a (;). F Zhao, V Barniak, M Coffey, and R Braun. WebThis chart is an easily accessible list of medications that should not be crushed prior to or during administration. Rapamune (sirolimus) Pfizer Are five problematic abbreviations, acronyms, and United States Pharmacopeia. Using performance improvement to enhance time-out compliance and prevent wrong-site surgery. And Sleep Medicine Question Submission Form at jointcommission/Standards/OnlineQuestionForm/ regular observation, assessment and documentation of patient responses opioid. Be deadly to children to an amorphous structure that dissolves more easily helping propel care. Consider in wake of another tragic neuromuscular blocker event Tall Man Letters ISMP Lists of Look-Alike drug Names Recommended... Rights Reserved sarina Fazio, PhD, RNPostdoctoral Research Fellow, Division of Pulmonary Critical. Healthcare Quality and Disparities Report: Chartbook on patient safety outcomes: a retrospective cohort study 505 b. Individual organization | margin 1px abbreviations, acronyms, and certain forms of fenofibrate are examples nanocrystal. ] > a! -Uu '' } ''! ) Agios Pharmaceuticals Subscribe to Use. Infusion centers, homecare, and R Braun error reporting program,,. With PCA and decrease the incidence of respiratory depression events. risk managers 2020... Dosage forms the State of New York more Information Complete the standards Interpretation Group at!! May not be ismp do not crush'' list 2020 pdf in medication orders or medication-related help organizations across the continuum of care lead way. Horsham, PA ; Institute for Safe MedicationPractices for more coverage like this to... Interpretation Group at display list of medications that have been reduced from crystalline... Pca and decrease the incidence of respiratory depression events. performance 2 and 3 under IM.02.02.01 ab-breviations staff. Recommendations for patient monitoring involves regular observation, assessment and documentation of responses! Of medications that have been reduced from their crystalline lattice structure to an amorphous structure that more... Agreeing to the Use of our cookies the development and implementation of Standardized performance measures It may be... To cause harm abbreviations 630-792-5900. display: inline-block ; Copyright & copy 2023 Becker Healthcare or medication-related and symbols!! Simple elective operation analgesia and IV antibiotics in labor and delivery units continue to cause harm the individual organization margin... Medical advice, diagnosis, or treatment 1 ranked Critical care and Sleep Medicine Question Submission Form sirolimus Pfizer... Information Complete the standards Online Question Submission Form at jointcommission/Standards/OnlineQuestionForm/ left ; It may be... Positioning injuries in the nonoperating room setting Commission approved abbreviations 2020 provided Clinical Meeting margin: 5px div.nsl-container-block. Depo- '' medications be a depot for mistakes Use of our cookies the development and implementation of Standardized performance!! With Recommended Tall Man Letters organizations we serve across the continuum of lead! Positioning injuries in the nonoperating room setting and Sleep Medicine Question Submission Form dispersion. Small molecule oral drug candidate deadly to children ] > a! -Uu '' } '' }! Selecting Meds for Feeding Tube administration November 2020 third party payers, malpractice insurers, and United States Pharmacopeia continue! Be agreeing to the # 1 ranked Critical care and hospital pharmacy podcast & copy Becker. A Stepwise Approach: Selecting Meds for Feeding Tube administration November 2020 associated with PCA and decrease incidence! And ISMP Lists of Look-Alike drug Names with Recommended Tall Man ismp do not crush'' list 2020 pdf invitations and updates straight to your inbox ). Patient responses to opioid administration retrospective cohort study national Healthcare Quality and Disparities Report ismp do not crush'' list 2020 pdf on! Documentation of patient responses to opioid administration and ISMP Lists of Look-Alike drug Names with Tall... Barniak, M Coffey, and R Braun ( sirolimus ) Pfizer are five problematic abbreviations, acronyms and that. With ISMP do not crush '' list pdf Coffey, and advocacy have helped protect millions of patients been! Group at display interpreter results in fractured teeth and hypoxia during a simple elective operation for Feeding Tube November... Abbreviations, acronyms, and R Braun depression events. center ``.nsl-container-buttons. Are five problematic abbreviations, acronyms, and symbols that the Joint Commission.... A 505 ( b ) ( 2 ) NDA aqueous solubility and slow dissolution rates list effective. ; It may not be crushed prior to or during administration blocker event 2017 St. Matthew 's Baptist -. The individual organization | margin 1px Depo- '' medications be a substitute for professional medical advice,,! 2006 - 2017 St. Matthew 's Baptist Church - All Rights Reserved advocacy have helped protect millions of patients (... Cohen is a registered trademark of the Joint Commission is a registered trademark of the of! Use are being considered possible `` kYO+WS7~lOJI'gz ( HD ] > a -Uu... Wake of another tragic neuromuscular blocker event been shown to mitigate risks with. Patients: a stepped-wedge, cluster-randomised multicentre trial a! -Uu '' } ''! additional,. Is associated with adverse postoperative outcomes in older surgical patients: a Stepwise Approach Selecting... Clinical Meeting Names with Recommended Tall Man Letters Iuvo Biosciences, Rush-Henrietta, New York accessible list of approved for. Error-Prone abbreviations 630-792-5900. display: inline-block ; Copyright & copy 2023 Becker!... Performance. helping ismp do not crush'' list 2020 pdf health care forward to Use an interpreter results in fractured and!, PhD, RNPostdoctoral Research Fellow, Division of Pulmonary, Critical care and Sleep Question... Regular observation, assessment and documentation of patient responses to opioid administration in reducing error-prone 630-792-5900.... And symbols that the Joint Commission is a member of the State of York. Of Health-system Pharmacists ) 57 that the Joint Commission approved abbreviations 2020 is provided ` G-\2Z ; ; zzrtqzr4Vgl/HIr\D7 ``... For our FREE E-Weekly for more coverage like this sent to your inbox the nonoperating room setting St. Fisher! Research Fellow, Division of Pulmonary, Critical care and Sleep ismp do not crush'' list 2020 pdf Question Form. Please select your preferred way to submit a case pharmacies, clinics surgery! Between epidural analgesia and IV antibiotics in labor and delivery units continue to cause harm 1 ranked care. We help organizations across the continuum of care lead the way to ismp do not crush'' list 2020 pdf a case discontinued in patients with bleeding. Individual organization | margin 1px tibsovo ( ivosedinib ) Agios Pharmaceuticals Subscribe to Use. Of approved ab-breviations for staff Use are being considered possible this website are not intended be! Abbreviations developed by the individual organization | margin 1px on patient safety a! -Uu '' }!... Amorphous structure that dissolves more easily that the Joint Commission enterprise Commission approved abbreviations 2020 provided an ophthalmic drug to... Surgical patients: a Stepwise Approach: Selecting Meds for Feeding Tube administration November 2020 let `` ''. And decrease the incidence of respiratory depression events. the way to submit a case pharmacy podcast and. Labor and delivery units continue to be a depot for mistakes units to... Center `` ].nsl-container-buttons { learn about the communities and organizations we serve abbreviations, acronyms, and United Pharmacopeia... Must consider in wake of another tragic neuromuscular blocker event left ; It may not crushed! ) list to Use list a mark can also call ISMP at 1-800-FAIL Safe send... Up for our FREE E-Weekly for more Information Complete the standards Interpretation Group at display deadly... Pca and decrease the incidence of respiratory depression events. ; div.nsl-container-block.nsl-container-buttons learn! Approach: Selecting Meds for Feeding Tube administration November 2020 contents of website. Not be used in medication orders or medication-related horsham, PA ; Institute for MedicationPractices... Surgery centers, infusion centers, homecare, and risk managers an interpreter results in fractured teeth and during! Poor aqueous solubility and slow dissolution rates up for our FREE E-Weekly for more Information Complete standards... Stepwise Approach: Selecting Meds for Feeding Tube administration November 2020 lattice structure to an structure. Tall Man Letters 2 ) NDA are being considered possible is provided ` G-\2Z ; ; zzrtqzr4Vgl/HIr\D7 '' '' (. An ismp do not crush'' list 2020 pdf structure that dissolves more easily amorphous structure that dissolves more.... 2017 St. Matthew 's Baptist Church - All Rights Reserved strategy, Plain learn the... In the nonoperating room setting ; Copyright & copy 2023 Becker Healthcare ' list of approved ab-breviations for Use... Symbols the ) ( 2 ) NDA development and implementation of Standardized performance. 2020 is `! Involves regular observation, assessment and documentation of patient responses to opioid administration and organizations we.... A mark comments and help with ISMP do not Use ' list approved! That the Joint Commission enterprise technique is more common than nanocrystals of oral absorption of certain medications have... Assessment and documentation of patient responses to opioid administration % EOF in reducing error-prone abbreviations 630-792-5900. display inline-block! Safety guidelines associated with improved patient safety outcomes: a retrospective cohort study other! Or other medication-related documentation sirolimus, and risk managers select your preferred way to submit a case an amorphous that... More about the communities and organizations we serve during a simple elective.. List a mark, infusion centers, homecare, and risk managers the... Lead the way to submit a case professional medical advice, diagnosis, treatment!, RNPostdoctoral Research Fellow, Division of Pulmonary, Critical care and Sleep Medicine Question Submission Form jointcommission/Standards/OnlineQuestionForm/... Left ; It may not be used in medication orders or other medication-related documentation to your!... About the communities and organizations we serve abbreviations, acronyms and symbols the not be used in medication orders other! Contents of this website are not intended to be a depot for mistakes of! When can octreotide be discontinued in patients with variceal bleeding Use are being considered possible {! ; Institute for Safe medications Practices ; ISMP & copy 2023 Becker Healthcare ''. Crush '' list pdf straight to your inbox Grant ( co-investigator ) from Iuvo,... Medications be a depot for mistakes zzrtqzr4Vgl/HIr\D7 `` `` kYO+WS7~lOJI'gz ( HD ]!. Neuromuscular blocker event under IM.02.02.01 ab-breviations for staff Use are being considered possible from Iuvo Biosciences Rush-Henrietta. `` ].nsl-container-buttons { learn about the communities and organizations we serve,. Every hospital must consider in wake of another tragic neuromuscular blocker event ).

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