To: Nursing, Pharmacy, Physician Staff
From: Maryna Shayuk, Chair Pharmacy and Therapeutics
Alan Mader, Pharmacy Clinical Coordinator
Re: Drug Shortage: 0.45% NS liter bags
|0.45% NS in liter bags have been placed on shortage at this time.
|This shortage was unexpected and was announced today.
|Substitution during this shortage will be necessary
|Pharmacy will utilize the following plan to substitute orders written for 0.45% NS:
0.45% NaCl to 0.9% NaCl – for pre & post-surgery.
If patient is hypernatremic, substitute with Lactated Ringers.
All other orders call MD.
Pharmacy services will place “Substituted for ________” in the comment section of the Paragon order so that nursing is aware of the change.
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.
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.
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
Originally published on March 12, 2016. This procedure is still valid for version 13.x
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
Did you know that most patients who give a history of “penicillin allergy” do not have a true allergy? Most of them will tolerate more effective and less expensive agents without issues.
For more information see the recently updated policy.
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.
Thank you very much for your consideration.
September 22, 2016 issue
Volume 16, Number 5
Table of contents
Enoxaparin Injection Sites
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.
Loxapine Inhalation (ADASUVE) Read more here … pt-newsletter-16-5-092216pt
Formulary Additions for Lurie Pediatric Patients
- 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.