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.
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.
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
From: Dima Awad, PharmD, MS, System Director of Pharmacy Services
Date: August 31, 2017
Re: D5W/0.45% NS Shortage
We are experiencing a shortage in D5W/0.45% NS.
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.
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.
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.