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Paragon remote access changed

Please note that as of 10/14/2018 Paragon remote access will be moved to https://citrix.centegra.com

Paragon will no longer be available through access.centegra.com

**Update** Heart Failure Module updated and available to use

The new Heart Failure module has been updated and active at both McHenry and Huntley.  The old module has been removed.  Please review the image below for instructions on how to access this module in Paragon Clinician Hub.

**Now Available** PERT PULMONARY EMBOLISM Order Set

The PERT PULMONARY EMBOLISM orders are active at both Huntley and McHenry. You can locate it by searching this title in the “Ordering” tab of the Paragon Clinician Hub.

DiphenhydrAMINE Injection Shortage 10.15.18

To:            Physicians, Nursing, Pharmacy

From:     Maryna Shayuk, MD, Chair Pharmacy and Therapeutics

                  Alan Mader, Pharmacy Operations Coordinator

Date:        October 15, 2018

Re:            Diphenhydramine Injection Shortage

S

Situation

Diphenhydramine injection supply is critically low. Estimates indicate less than a 2 week supply throughout NM Northwest system.
B

Background

Diphenhydramine has been on shortage. Pharmacy Purchasing has been able to obtain orders up to this point.
A

Assessment

In order to maintain the limited supply for crash cart exchange, sequestering to pharmacy and therapeutic substitution will need to be instituted.
R

Recommendation

Pharmacy will sequester remaining supply from Pyxis machines to the Pharmacy Department.   Therapeutic Substitution will take place as follows:

Injection to PO – For all patients who can take PO in equivalent dose.

If unable to take PO – Therapeutic substitution to Promethazine Injection in equivalent dose.   Doses greater than 25 mg – consult with MD.

 

Dexamethasone 10 mg/1 mL Preservative Free SHORTAGE 10.4.18

To:             Physician, Nursing, and Pharmacy Staff

From:        Alan Mader, PharmD, Pharmacy Clinical Coordinator

Date:         10/4/18

Re:             Dexamethasone 10 mg/mL 1 mL Injection PF Shortage

S

Situation

 

We have been notified that dexamethasone 10 mg/mL 1 mL PF has been placed on the shortage list.

B

Background

 

This shortage has been newly announced.

A

Assessment

The quantity of 1 mL PF vials available at NWM, NWH, NWW is 110.  The usual consumption at NWH is approximately 18 per day, with NWM and NWW being less.  Based on that number and the ability to shift product between campuses, we have about a 5 day supply available.  The shortage is expected to last from the end of October to mid-November, so that likelihood that supply will become depleted is strong.
R

Recommendation

 

Utilize dexamethasone 10 mg/mL 1mL Injection with preservatives wherever possible.

Sodium Bicarbonate Inj Shortage 10.1.18

To:      Physician, Nursing and Pharmacy Staff
From: Maryna Shayuk, MD, Chair, Pharmacy and Therapeutics
            Alan Mader, PharmD, Pharmacy Clinical Coordinator
Date:   9/26/2018
Re:        Sodium Bicarbonate Injection Shortage

Situation

Sodium Bicarbonate 8.4% Injection 50 mL is currently on shortage. There are different projections on how long this shortage will last, with some continuing until 2019. Sodium Bicarbonate is used for CODE BLUE situations and is available in Crash Carts. It is also used for Open Heart Surgery and for Toxicologic Emergencies.

Background

The supply of Sodium Bicarbonate 8.4% Injection has not been stable for some time.

Assessment

With uncertain supply, steps to maintain availability for Crash Cart Supply and for Open Heart Surgery need to be implemented.

Recommendation

Pharmacy will sequester supply to maintain stock for Crash Carts and for the surgical Open Heart room. When orders are received for sodium bicarbonate infusion, pharmacy will directly provide recommendation with the ordering physician to use sodium acetate injection. Information on the use of sodium acetate infusion is shown below:

Toxicologic Emergencies – Use Sodium Acetate 2 mEq/mL
a. Bolus (if required) – 1 mEq/kg/D5W 500 mL infused over 20 minutes (consistent
with information presented by ASHP). 150 mEq maximum to avoid osmolarity issues.
For patients over 100 Kg, infuse over 30 minutes.
b. Maintenance: Na Acetate 150 mEq/D5W 1000mL infused at 200 mL/hr for adult
patients. 3 bag limit. The same rate would be used for urine alkalinization.

We are anticipating that the shortage will end before supply becomes depleted. If that is not the case, sodium acetate may also be used in Code situations as follows:

Crash Cart/Code situation – Requires dilution/infusion. 50 mEq Sodium Acetate added to 100 mL D5W (125mL TV) administered over 10 minutes

Sodium Phos and Potassium Phos Inj Shortage 10.1.18

To:      Physician, Nursing and Pharmacy Staff
From: Alan Mader, Pharmacy Clinical Coordinator
Date:  10/1/2018
Re:       Sodium Phosphate Injection Shortage
             Potassium Phosphate Injection Shortage

Situation

Both Sodium Phosphate and Potassium Phosphate Injection are on shortage. Currently the system is in very low supply of Sodium Phosphate and pharmacy has transferred supply from the Huntley campus to the McHenry campus. The Sodium Phosphate shortage is projected to last 2 to 4 weeks. The Potassium Phosphate shortage is projected to last until late December.

Background

These shortages have been newly announced.

Assessment

Sodium Phosphate supply is very low within the system (17 vials). While Potassium Phosphate is currently in greater supply, projections indicate that it may remain on the shortage list an additional month longer that Sodium Phosphate.

Recommendation

Please conserve both Sodium and Potassium Phosphate Injection. Wherever possible, please consider oral replacement with Neutra Phos equivalent. Each packet contains: Sodium 160 mg (7.1 mEq), Potassium 280 mg (7.1 mEq), Phosphorus 250 mg (8 mMol).

**Paragon Downtime** – 09_19_2018 / 1am – 5am

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