DiphenhydrAMINE Injection Shortage 10.15.18

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

S

Situation

Diphenhydramine injection supply is critically low. Estimates indicate less than a 2 week supply throughout NM Northwest system.
B

Background

Diphenhydramine has been on shortage. Pharmacy Purchasing has been able to obtain orders up to this point.
A

Assessment

In order to maintain the limited supply for crash cart exchange, sequestering to pharmacy and therapeutic substitution will need to be instituted.
R

Recommendation

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.

 

Dexamethasone 10 mg/1 mL Preservative Free SHORTAGE 10.4.18

To:             Physician, Nursing, and Pharmacy Staff

From:        Alan Mader, PharmD, Pharmacy Clinical Coordinator

Date:         10/4/18

Re:             Dexamethasone 10 mg/mL 1 mL Injection PF Shortage

S

Situation

 

We have been notified that dexamethasone 10 mg/mL 1 mL PF has been placed on the shortage list.

B

Background

 

This shortage has been newly announced.

A

Assessment

The quantity of 1 mL PF vials available at NWM, NWH, NWW is 110.  The usual consumption at NWH is approximately 18 per day, with NWM and NWW being less.  Based on that number and the ability to shift product between campuses, we have about a 5 day supply available.  The shortage is expected to last from the end of October to mid-November, so that likelihood that supply will become depleted is strong.
R

Recommendation

 

Utilize dexamethasone 10 mg/mL 1mL Injection with preservatives wherever possible.

Sodium Bicarbonate Inj Shortage 10.1.18

To:      Physician, Nursing and Pharmacy Staff
From: Maryna Shayuk, MD, Chair, Pharmacy and Therapeutics
            Alan Mader, PharmD, Pharmacy Clinical Coordinator
Date:   9/26/2018
Re:        Sodium Bicarbonate Injection Shortage

Situation

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.

Background

The supply of Sodium Bicarbonate 8.4% Injection has not been stable for some time.

Assessment

With uncertain supply, steps to maintain availability for Crash Cart Supply and for Open Heart Surgery need to be implemented.

Recommendation

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

Sodium Phos and Potassium Phos Inj Shortage 10.1.18

To:      Physician, Nursing and Pharmacy Staff
From: Alan Mader, Pharmacy Clinical Coordinator
Date:  10/1/2018
Re:       Sodium Phosphate Injection Shortage
             Potassium Phosphate Injection Shortage

Situation

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.

Background

These shortages have been newly announced.

Assessment

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.

Recommendation

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).

**Paragon Downtime** – 09_19_2018 / 1am – 5am

AlertMD – Password Reset Instructions

Please review the image below for AlertMD password reset instructions.

**Update** – New Paragon Documentation by Specialty

Progress / Resident Progress and Consultation Notes are now available by your “Specialty“. The breakdown of these documentation via specialty will make it easier for all Physicians’ to understand the type of note documented for each patient profile. The content for all the notes are the same for all of the specialties. This is active for all locations: Huntley, McHenry and Woodstock. When searching for a documentation, you can search by your specialty, so the result(s) can be populated unique to your specialty.  Below are the new specialties added for each of the note title. Review the image below, on how the documentation list would view once signed.

Specialties included for Progress / Resident Progress and Consultation Notes are:

  1. Cardiology
  2. Pulmonary
  3. ID
  4. Nephrology
  5. GI
  6. Endocrine
  7. Neurology

Naming convention to search for each specialty:

Your Specialty” Consultation Note – example:  Cardiology Consultation Note

Your Specialty” Progress Note – example: Cardiology Progress Note

Resident “Your Specialty” Progress Note – example: Resident Cardiology Progress Note

 

 

 

 

 

How to Invalidate Documentation in Paragon Clinician Hub?

In Paragon Clinician Hub, when a document has been entered under the wrong visit ID or for any other reason the document needs to be removed from the record, it needs to be Invalidated.

If you have received a notice stating that you need to make this change, please utilize the instructions below. For additional visual training, a screen shot and a link to a video has been added below as well.

  1. Go to Census, locate visit where the document should be entered by entering the Visit ID supplied by Medical Records into the search field.
  2. Recreate the note under the correct visit ID, noting that the date is editable.
  3. Go back to the Census Tab.
  4. Locate visit where the document is entered in error by entering the “wrong” Visit ID supplied by Medical Records into the search field.
  5. Open the note in question, and locate the icon next to red X in the upper right hand corner; click the invalidate icon and choose a reason for invalidating.

Video on how to Invalidate: https://youtu.be/3YlLdtKPqzY

 

**UPDATE** – NEW History and Physical Update 1001 Documentation in Paragon

History and Physical Short form is no longer available for any sites.

The new “History and Physical Update 1001” will replace the short form.  Providers must use the History and Physical 1000 for INITIAL documentation.

History and Physical Update 1001 is to be only used for updates to H&P’s created within the last 30 days for out-patient procedures and inpatient admissions.

If a History and Physical 1000 does not exist, one must be completed.

Please review the visual below for additional information.