**Update** – Modifications made to Orders Sets

The following Order Sets have been modified:

Chest Pain Converting to NSTEMI Module H        Chest Pain Converting to NSTEMI Module M
Unstable Angina/Non STEMI H                                Unstable Angina/Non STEMI M
ORTHO Hip Replacement Post Op H
ORTHO Knee Replacement Post Op H

Hypothermia Order Sets MODIFIED

The hypothermia order sets have been modified to account for new criteria. Updated for McHenry and Huntley locations.

The new naming convention is as follows for all hypothermia order sets:

Targeted Temperature Mgmt TTM Pre Induct/Induct (M or H)

Targeted Temperature Mgmt TTM Maintenance (M or H)

Targeted Temperature Mgmt TTM Maint Timed Labs (M or H)

Targeted Temperature Mgmt TTM Rewarming  (M or H)

Lorazepam Injection Shortage 12.5.18

To:            Physicians, Nursing, Pharmacy

From:     Alan Mader, Pharmacy Clinical Coordinator

Date:      12/5/2018

Re:   Lorazepam Injection Shortage

SituationLorazepam 2mg/mL 1 mL vials are on manufacturer on backorder.   The estimated re-supply date of November 2018 has already been exceeded.  Other projections for release include December 2018 to January 2019, with others extending to January 2020.
BackgroundLorazepam 2 mg/mL 10 mL vials have been on backorder since November 2017.
AssessmentThe addition of the 1 mL vials to backorder status severely limits availability of lorazepam injection.  While the pharmacy maintains some supply of lorazepam injection, the probability of depletion of stock before repletion is high.  Use of other benzodiazepines may become necessary.
RecommendationFor patients who currently require lorazepam, please consider use of the PO route whenever possible.

While there are no direct dose conversions between benzodiazepines, please consider the following information on pharmacokinetics to aid in selection of an alternative:

MedicationOnset

IV (minutes)

Onset

IM (minutes)

Duration

IV

(hours)

Duration

IM

(hours)

T ½

(Hours)

Active metabolites
Diazepam

(currently available in MDV’s only)

1 to 5Slow and erratic absorption0.3 to 0.5Slow and erratic absorption20 to120Yes
Lorazepam5 to 2015 to 306 to 86 to 88 to15No
Midazolam

5 mg/1 mL

5 mg/5 mL

2 mg/2mL

1 to 55 to 15≤22*3 to 11Yes

Pharmacologic effect of Midazolam may last up to 6 hours in some patients

Drug Shortage 0.45% NS Liter Bags 11.27.18

To:            Nursing, Pharmacy, Physician Staff

From:     Maryna Shayuk, Chair Pharmacy and Therapeutics

Alan Mader, Pharmacy Clinical Coordinator

Date:        11/27/18

Re:            Drug Shortage:  0.45% NS liter bags

S

Situation

0.45% NS in liter bags have been placed on shortage at this time.
B

Background

This shortage was unexpected and was announced today.
A

Assessment

Substitution during this shortage will be necessary
R

Recommendation

Pharmacy will utilize the following plan to substitute orders written for 0.45% NS:

0.45% NaCl to 0.9% NaCl – for pre & post-surgery.

If patient is hypernatremic, substitute with Lactated Ringers.

All other orders call MD.

Pharmacy services will place “Substituted for ________” in the comment section of the Paragon order so that nursing is aware of the change.