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.
Please note that CHS is instituting a new policy regarding the order of Non-Formulary medications. The ordering of Non-Formulary medications will include completion of the Non-Formulary Use Request. When requests have been completed, they are to be sent to the Pharmacy Department. The Pharmacy Director, Dima Awad, will be reviewing all requests for approval to use. This pertains to all Inpatient and all Outpatient (SAGE, ATC/ATS) requests. Pharmacy will be collecting data on requests which will assist in determining the need of products for Formulary Addition. Also included is the most recent approved Therapeutic Interchange List for your review.
As we know, administration of subcutaneous enoxaparin (LOVENOX) should be alternated between the left and right anterolateral and left and right posterolateral abdominal wall. Pharmacy has received requests for administration to be made in areas such as the thigh. Research into alternate site administration is limited. Only one study was found which compared enoxaparin administration into the thigh versus the standard injection site. This study was conducted in obese patients and found that when enoxaparin was injected into the thigh, anti Xa levels were found to be significantly lower. Based on this limited information and the inability to monitor in-house anti Xa levels at CHS, administration at the sites outlined by the manufacturer should be followed.
Ampicillin sulbactam (UNASYN) 1.5 GM for injection – added with pediatric restriction
Cefotaxime (CLAFORAN) 500 mg, 1 GM, 2 GM for injection – added with pediatric restriction
Ibuprofen chewable tablet 50 mg and 100 mg – added for pediatrics
Montelukast (SINGULAR) 5 mg tablet – added for pediatrics
Ranitidine (ZANTAC) 15 mg/mL Syrup – added for pediatrics
Sodium Chloride 3% Nebs – added for pediatrics
Vitamin A & D Ointment – added for pediatrics
Sacchromyces boulardi (FLORASTOR) 250 mg capsule and packet – add for pediatric and adult patients
Alvimopan (ENTEREG) – Pharmacy will maintain supply until current stock expires. If this product has little or no use, it will be removed from formulary.
Lidocaine 5%/D7.5W (PF) 100 mg/2 mL injection
Bupivacaine-dextrose-water (PF) 15 mg/2 mL injection
Heparin 1000 units/mL 30 mL MDV
Tromethamine 36 mg/mL 500 mL solution for injection (THAM) – off market
Sodium polystyrene sulfonate powder 454 GM
Acetaminophen IV(OFIRMEV) 650 mg for nonpediatric patients
Acetaminophen IV (OFIRMEV) 1000 mg
Zolpidem CR (AMBIEN CR) 12.5 mg or 6.25 mg
Zolpidem (AMBIEN) 5 mg
Brinzolamide (AZOPT) Ophthalmic Solution 1 drop tid affected eye(s).
Dorzolamide (TRUSOPT) Ophthalmic Solution 1 drop tid affected eye(s).
7300–531PT Medication Order Duration Policy This policy, which specifies medication order duration based on individual medication or medication class type, had previously been deleted. At the February, 2016 Pharmacy and Therapeutics Committee meeting, it was resurrected so that appropriate durations could be placed in Paragon. The revision that was made at this time was reorganization to make incorporation into Paragon easier.
7300–621PT Argatroban Dosing and Monitoring per Pharmacy Protocol This protocol has been used for many years without substantial change. It details Argatroban dosing and dose adjustment when the drug is used for heparin induced thrombocytopenia or heparin induced thrombocytopenia with thrombotic syndrome. The only change that was made at this time regards removal of wording for a paper order.
7300–690PT Pediatric Medication Preparation and Administration This policy, recognizing that the pediatric population has significant specific needs, an interdisciplinary process is designed to ensure that pediatric medication therapy is prepared and dispensed in a safe, effective, and timely manner and that all medications administered to pediatric patients are given accurately, safely, and with proper technique for each method of administration. The change that was made to this policy was the removal of the 0.1 mL overfill on IM and subcutaneous medications drawn up by Pharmacy.