Category Archives: Pharmacy

Allergies will be listed as unknown severity by nursing staff

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.

Potassium Chloride Injection Shortage

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.

Influenza Vaccination in Patients with Egg Allergy

Guideline Watch | GENERAL MEDICINE, INFECTIOUS DISEASES

January 11, 2018

Influenza Vaccination in Patients with Egg Allergy

David J. Amrol, MD reviewing Greenhawt M et al. Ann Allergy Asthma Immunol 2018 Jan .

All available flu vaccines are safe in all egg-allergic patients.

Sponsoring Organizations: American Academy of Allergy, Asthma, and Immunology (AAAAI); American College of Allergy, Asthma, and Immunology (ACAAI)

Target Audience: All providers who administer influenza vaccines

Background

Historically, patients with egg allergy have been told to avoid flu vaccines, because most flu vaccines are produced in embryonated chicken eggs; the concern was that a vaccine might contain residual egg protein, which could lead to anaphylaxis. Many studies have shown that flu vaccines are safe for egg-allergic patients, but many physicians still have been hesitant to vaccinate such patients. This updated practice parameter incorporates recent data on flu vaccine safety in egg-allergic patients, including children.

Key Recommendations

  • Flu vaccines should be administered annually to patients with egg allergy of any severity, with no need to ask recipients about egg-allergy status and no special precautions beyond those recommended for administering any vaccine to any patient. This recommendation applies to both injected and intranasal formulations (although the latter should not be used in the 2017−2018 flu season).
  • Non−egg-containing vaccines can be used but are not necessary or preferred over standard vaccines.
  • The intranasal live attenuated flu vaccine also might be used, if it’s shown to be efficacious and is approved for use.
Comment

Egg-allergic patients can be vaccinated safely with any available age-appropriate flu vaccine, with no special precautions, regardless of egg-reaction history (including anaphylaxis). Concern for egg allergy only adds another barrier to universal flu vaccination, and this practice parameter concludes by stating the following: “Vaccine providers and screening questionnaires do not need to ask about the egg allergy status of recipients of influenza vaccine.”

Editor Disclosures at Time of Publication

Disclosures for David J. Amrol, MD at time of publication

Consultant / Advisory board CSL Behring; Horizon Pharmaceuticals
Citation(s):

Greenhawt M et al. Administration of influenza vaccines to egg allergic recipients: A practice parameter update 2017. Ann Allergy Asthma Immunol 2018 Jan; 120:49. (http://dx.doi.org/10.1016/j.anai.2017.10.020)

DOBUTamine Shortage 11.15.17

Physicians,

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.

Thank you,

Alan Mader, PharmD, BCPS

Clinical Coordinator

Department of Pharmacy Services

Centegra Health System

815-759-4407

Morphine Injection Shortage

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.

A

Analgesic

B

Oral

C

Parenteral

D

Oral: Parenteral Ratio

E

Oral Morphine: Analgesic Ratio

F

Analgesic Duration

G

Half Life

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

Ordering Pharmacist Dosing of Antibiotics

Paragon version 12.x

Antibiotics can be dosed by a clinical pharmacist for all inpatients. Dosing is done through P&T approved protocols.

To order:

  1. Go to Paragon clinician hub
  2. Ordering tab
  3. Order Queue
  4. Search for “antibiotics”
  5. Select RX formulary oral & injectable antibiotics

Please DO NOT order in any of the following

  1. As a miscellaneous nursing order
  2. As a message to the pharmacist
  3. In the comments section of an antibiotic order

D5W / 0.45% NS Shortage 9.1.17

To:      Company-Wide

From: Dima Awad, PharmD, MS, System Director of Pharmacy Services

Date:  August 31, 2017

Re:      D5W/0.45% NS Shortage

SITUATION

We are experiencing a shortage in D5W/0.45% NS.

BACKGROUND

Medications including IV fluid shortages keep occurring at great frequency, this situation has been worsening over the past several years due to multiple factors such as fewer suppliers, inability to acquire active ingredients, issues with packaging and more.

ASSESSMENT

Currently, Pharmacy services has a 1 day supply of D5W/0.45% NS. When the current supply of D5W/0.45% NS becomes depleted, a plan for automatic substitution needs to be implemented. This is not a new workflow nor is it a change in practice in case of shortages.

RECOMMENDATION

When supply becomes depleted, Pharmacy services will initiate substitution with D5W/0.225% NS, to be administered at same infusion rate that was ordered. Pharmacy services will place “Substituted for D5W/0.45% NS” in the comment section of the Paragon order so that nursing is aware of the change. This substitution has been approved by The Pharmacy and Therapeutics Committee. Pharmacy will also maintain vigil on availability of D5W/0.225%, as we anticipate that increased use will decrease supply.

 

pembrolizumab (KEYTRUDA) in Patients with Multiple Myeloma: FDA Statement – Two Clinical Trials On Hold

Keytruda (pembrolizumab) in Patients with Multiple Myeloma: FDA Statement – Two Clinical Trials on Hold
AUDIENCE: Oncology
ISSUE: Based on data from two recently halted clinical trials, the U.S. Food and Drug Administration today is issuing this statement to inform the public, health care professionals, and oncology clinical investigators about the risks associated with the use of Keytruda (pembrolizumab) in combination with dexamethasone and an immunomodulatory agent (lenalidomide or pomalidomide) for the treatment of patients with multiple myeloma. Keytruda (pembrolizumab) is not approved for treatment of multiple myeloma.
The FDA statement is based on review of data from two clinical trials (KEYNOTE-183 and KEYNOTE-185) evaluating the use of Keytruda (pembrolizumab) combined with other treatments in patients with multiple myeloma. On July 3, 2017, the FDA required that all patients in these trials be discontinued from further investigation with this drug, because interim results from both trials demonstrated an increased risk of death for patients receiving Keytruda (pembrolizumab) when it was combined with an immunomodulatory agent as compared to the control group (see statistical analysis section below). Merck & Co., Inc. was made aware of the issue through an external data monitoring committee recommendation and suspended the trials to enrollment on June 12, 2017. Continue reading

Johns Hopkins ABX Guides

Pharmacy Services has subscribed to Johns Hopkins ABX Guide for use by all associates at Centegra Health System to support our multidisciplinary approach to the Antimicrobial Stewardship Program Clinical Decision Support Tools and Education

Johns Hopkins ABX Guide is a comprehensive web source that provides regularly updated, evidence-based decision resources regarding antibiotics, diagnosis, pathogens, management of infections and vaccines.

Prior to the Guide, CHS did not have a specific detailed resource for antibiotics clinical decision support.

Johns Hopkins ABX Guide may be accessed through Unbound Medicine’s uCentral as follows:

QUAD Strength Vasopressors

The following will no longer be available for use at CHS:

  • QUAD Strength NorEPINEPHrine
  • QUAD Strength Phenylephrine

Thank you,

Alan Mader, PharmD, BCPS, Pharmacy Clinical Coordinator  815-759-4407