Nursing and pharmacy will list patient allergies in the EMR. The severity of the allergy cannot be assessed by the nursing and pharmacy staff. Therefore the allergy severity will be listed as “unknown”. This will default to the presumed to be severe for the drug alerting.
Physicians can go and edit the severity based on history and clinical judgement.
Please edit the informant source to physician. This will allow the severity to flow from one admission to the next.
Centegra lab will now perform an e-test on all MRSA isolates obtained from a sterile site with microscan mic >=2.
With additional testing e-testing many isolates may have lower had mic of <1.5 expanding options for treatment.
This additional step will take an additional day to report out.
We have been alerted by Pfizer Inc. that Potassium Chloride Injection will experience a supply interruption due to Hurricane Maria and the inability of their other manufacturing plants to keep up with demand. The Pharmaceutical Purchasing Group at CHS checks for supply on a daily basis. While we expect some supply to arrive this week, our stock is very low at this time. Please consider the use of oral potassium products wherever possible. Potassium Acetate and Potassium Phosphate riders are an alternative in appropriate patients. In addition, Large Volume Parenteral Products (D5% – 0.2% NS with KCL, D5%-0.45% with KCL and D5% – 0.9% NS with KCL) are other alternatives.
Thank you for your assistance during this shortage.
Starting Feb 2018 we will move to a three tiered system of antimicrobial stewardship. For all the details go to Clinical -> Infection prevention -> Antimicrobial Stewardship.
IDSA and SHEA have updated guidelines for 2017. Please see here for details.
For other guidelines
Please note that the CT Chest ILD protocol is specifically to evaluate for and differentiate between different types of interstitial lung diseases and includes expiratory phase and prone imaging. Usually this is on patients with known pulmonary fibrosis or longstanding shortness of breath. Also this is usually ordered by pulmonologists on outpatients. If a patient is acutely short of breath, has a lung nodule/mass, or in the hospital, usually a CT chest is the more appropriate order. This was previously named “High-Resolution Chest CT,” but the name was changed to better reflect it’s intended use. All of our CTs are high resolution.
There is a nationwide shortage on DOBUTamine 500 mg/250 mL IVPB. At present consumption, we expect CHS has about a 12 day supply. We may continue to receive backordered quantity, but we cannot rely on this. Please be aware of this shortage and consider alternatives as our supply depletes.
Alan Mader, PharmD, BCPS
Department of Pharmacy Services
Centegra Health System
Morphine Injection Shortage 10.18.2017
There is a nationwide shortage of morphine injection that expected to last until early to mid-November. The Pharmacy Department is running very low on supply and expects that the drug will become unavailable. Please consider ordering an alternate injection product for pain management. An opioid dose conversion chart is included below for your convenience.
Oral: Parenteral Ratio
Oral Morphine: Analgesic Ratio
|Morphine ||30 mg ||10 mg ||3 : 1 ||1 : 1 ||4 – 6 hrs ||3 hrs |
|Oxycodone ||20 mg ||— ||— ||1.5 : 1 ||3 – 5 hrs ||4 – 5 hrs |
|Hydromorphone ||7.5 mg ||2 mg || 4: 1 ||4: 1 ||3 – 4 hrs ||2 – 3 hrs |
|Fentanyl ||— ||100 mcg ||— ||See Table B on page 2 ||1 hr ||3 – 12 hrs |
|Methadone ||20 mg ||10 mg ||2 : 1 ||See Table C on page 2 ||4 – 12 hrs ||15 – 50 hrs |
|Codeine ||200 mg ||130 mg ||1.5 : 1 ||1 : 7 ||4 – 6 hrs ||3 hrs |
|Hydrocodone ||30 mg ||— ||— ||1 : 1 ||3 – 6 hrs ||3 – 4 hrs |
|Meperidine ||300 mg ||75 mg ||4 : 1 ||1 : 10 ||2 – 4 hrs ||2 – 3 hrs |
|Nalbuphine ||— ||10 mg ||— ||1 : 1 ||3 – 6 hrs ||5 hrs |
Paragon version 12.x
Antibiotics can be dosed by a clinical pharmacist for all inpatients. Dosing is done through P&T approved protocols.
- Go to Paragon clinician hub
- Ordering tab
- Order Queue
- Search for “antibiotics”
- Select RX formulary oral & injectable antibiotics
Please DO NOT order in any of the following
- As a miscellaneous nursing order
- As a message to the pharmacist
- In the comments section of an antibiotic order