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.
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.
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.
Keytruda (pembrolizumab) in Patients with Multiple Myeloma: FDA Statement – Two Clinical Trials on Hold
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
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:
The following will no longer be available for use at CHS:
- QUAD Strength NorEPINEPHrine
- QUAD Strength Phenylephrine
Alan Mader, PharmD, BCPS, Pharmacy Clinical Coordinator 815-759-4407