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
|Diphenhydramine injection supply is critically low. Estimates indicate less than a 2 week supply throughout NM Northwest system. |
|Diphenhydramine has been on shortage. Pharmacy Purchasing has been able to obtain orders up to this point. |
|In order to maintain the limited supply for crash cart exchange, sequestering to pharmacy and therapeutic substitution will need to be instituted. |
|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.
To: Physician, Nursing and Pharmacy Staff
From: Maryna Shayuk, MD, Chair, Pharmacy and Therapeutics
Alan Mader, PharmD, Pharmacy Clinical Coordinator
Re: Sodium Bicarbonate Injection Shortage
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.
The supply of Sodium Bicarbonate 8.4% Injection has not been stable for some time.
With uncertain supply, steps to maintain availability for Crash Cart Supply and for Open Heart Surgery need to be implemented.
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
To: Physician, Nursing and Pharmacy Staff
From: Alan Mader, Pharmacy Clinical Coordinator
Re: Sodium Phosphate Injection Shortage
Potassium Phosphate Injection Shortage
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.
These shortages have been newly announced.
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.
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).
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.
Potassium Chloride Injection Shortage – although product is still in short supply, Centegra pharmacies have been successful in obtaining supply. The manufacturer expects release on 8/23/18. At this time, we estimate we have at least a 4-week supply and can now begin using without restriction.
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.