Antimicrobial Stewardship – New Program

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.

Clostridium Difficile Guidelines 2017 – Updated

IDSA and SHEA have updated guidelines for 2017. Please see here for details.

For other guidelines

CT Chest ILD Protocol

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.

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)

Flu Season Guidelines from IDSA

Flu season is up us. Please see these guidelines for this season from Infectious Disease Society of America for current updates.

Paragon Downtime

Paragon will not be available from 10:00 pm Tuesday 1/9/2018 through 6:00 am 1/10/2018 while the database is being upgraded.

MPF will be available to pull up past notes.

Centricity Downtime 11/17-11/21

Please be aware that Centricity DMS (Cardiology application) will experience downtime this weekend for a system upgrade.  Users will NOT be able to log into Centricity DMS and/or send images to Centricity.  A hard  copy of the Downtime Resource Guide is always available on each unit as well as an electronic copy is located on the Centegra Portal.

When will Centricity DMS go offline?
Friday, November 17th @ 5p

When will Centricity DMS be available again?
Tuesday, November 21st @ 5p

What will this affect?

  • Images can still be viewed by clinicians on ZFP Cardio Images
  • Medical Imaging will fax a form to the floors with preliminary findings from the Cardiologist’s readings
  • No official reports until Tuesday (this includes echo, cath and stress)
  • Preliminary reports will be available for EMERGENT echoes ONLY.  This report will only have pertinent findings and will be faxed to the patient’s POD.

Who will this affect?

  • Anyone that uses Centricity DMS
  • Anyone that needs a Cardiologist’s reading (echo, cath and stress)

Who can i contact for help?

  • For report issues please contact the reading Cardiologist directly
  • For all other questions, please contact the department

 

We apologize in advance for any delays this may cause.  We ask that you please be patient with this process as there will be likely delays in viewing echos in particular (due to a lengthy/cumbersome viewing process).  Please be sure to adjust your clinical care accordingly.

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

Did you know you can get ABIM MOC credits with Uptodate.com?

ABIM MOC completion can be done through Uptodate.com 

Please see here for more information on the program.

Centegra offers access to uptodate.com for all providers in the health system. Just login from any network computer in the system.

Instructions on remote or mobile access can be found here.

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