MEMO
To:
Pharmacy & Therapeutics Committee Members
cc.
Executive Council, Medical Executive Committee, Dept. Chiefs, Medical Staff, Nursing Directors
From:
Harold McGrade, M.D., and Chair
Date:
5/01/07
Re:
ACTIONS OF THE MAY PHARMACY AND THERAPEUTICS COMMITTEE MEETING
DECISIONS MADE/ACTIONS TAKEN
FYI- Haldol (Haloperidol) Warning Section Revised- The WARNINGS section of the Haldol (Haloperidol)
prescribing information has been updated to include Cardiovascular Effects:
“Rare cases of sudden death have been reported in psychiatric patients receiving antipsychotic drugs, including Haldol.
Since QT-prolongation has been observed during Haldol (or Haldol Decanoate) treatment, it is advised to be cautious in
patients with QT- prolonging conditions (QT- syndrome, hypokalemia, electrolyte imbalance, drugs known to prolong QT,
cardiovascular diseases, family history of QT prolongation), especially if Haldol is given parenterally.”
Advair (Fluticasone/Salmeterol) HFA Aerosol Inhaler- Line Item Extension- indicated for treatment of asthma and
COPD. The aerosol inhaler is RESTRICTED to patients on the ventillator who need steroid/Beta agonist treatment. Any
use in non-ventillator patients will REQUIRE justification of the use. The diskus inhaler is available for all non-ventillator
patients.
Cost- Advair Diskus Inhaler (14 day supply)100/50- $77.91 250/50- $96.14 500/50- $135.85
Advair HFA Aerosol Inhaler45/21- $117.78 115/21- $149.11 230/21- $205.92
Coreg CR (Carvedilol phosphate)- Line Item Extension- indicated for treatment of acute myocardial infarction with left
ventricular dysfunction, CHF, and hypertension. The CR product allows for once daily dosing at a comparable price to
the twice-daily Coreg.
Dose- 10mg-80mg once daily with food
Cost- 10mg, 20mg, 40mg 80mg tab- $3.19/day
Management of Warfarin Reversal- The committee approved guidelines for the management of warfarin reversal
including:
 Therapeutic options for reversing warfarin anticoagulation
 Reversing warfarin for patients requiring surgery or other invasive procedures
 Emergency Reversal of Anticoagulation: Guidelines for patients on warfarin
The guidelines will be distributed as educational information and made available in essential areas (ER, Stroke Unit, etc).
Recommended Dosing of Lovenox (Enoxaparin) in the Presence of Renal Insufficiency- The committee reviewed
guidelines for Lovenox dosing in renally compromised patients. Information regarding prophylactic heparin dosing in this
patient population will also be added to the guidelines and will be made available to the medical staff and other health
care professionals.
CLINICAL QUALITY
Medication Safety- Medication Reconciliation- The committee reviewed the revised medication reconciliation process
which includes:
 New White Side Tab in Chart for Med Reconcilliation/Allergy Inforomation
 Revised Home Medication Report which will be used to verify home meds and allergies as well as to order home
medications
 New Med Rec Report upon transfer, after surgery and at discharge which also lists home meds and allergies
The committee approved the recommendation to discontinue the automatic “stop” of medications and med profile when
patients are transferred into or out of the intensive care unit. Medications will no longer be discontinued WHEN a
patient is transferred into or out of an intensive care unit, unless ordered by the physician. This change will go
into effect on May 15 with the revised medication reconcilliation process.
Adverse Drug Reactions- (February 2, 2007- April 24,2007)- 28 reactions reported
 Six reactions did not require additional intervention for resolution of reaction.
 Nineteen required therapeutic intervention with no increased length of hospitalization.
 Three were associated with increased LOS or admission to the ER. Heparin, Benadryl and Reno-Dip were
associated with these reactions.
Heparin Arterial Line Flush Revision- The committee approved a recommendation to use only saline flushes for
arterial line management.
PCS Policy: Allergy Management- The committee approved the following portion of the new Patient Care Services
policy on Allergy Management:
A.
Medication ordered for which patient has stated allergy:
1.
If the physician wishes to order a drug for which the patient has a stated allergy, the physician should
include that information in the order, e.g. “aware of allergy.”
2.
If there is no clarification on the order, the nurse or the pharmacist will contact the physician for
clarification of the ordered medication and write a clarification order in the medical record.
EXCEPTION: The pharmacist will override the allergy alert and profile the medication if:
a.
The patient has received the medication for several doses/days without reaction on a previous
visit or current visit while allergy has been documented.
b.
Reported patient reaction is not severe, i.e. reaction not indicative of anaphylaxis—rash, hives,
SOB, arrest.
3.
If the medication is to be given, Pharmacy will profile the drug with the comment “ALLERGY evaluated
by RPh/physician” so that staff who subsequently administer the medication have appropriate
information.
The committee also approved an addition to the policy stating that the removal of a documented allergy from a patient’s
medical record will require a physician’s order to remove the allergy.
Antibiotic Effectiveness Team Update- the Antibiotic Effectiveness Team presented the following issues for
discussion:
 Availability of Antibiogram for 2006- posted on Intranet, hard copies are available from the lab
 Culture Reports- reports identifying patients with positive cultures within the last 5 days- these reports are sent to the
clinical pharmacists and made available on nursing units
 IV to PO Conversion- criteria for automatic conversion from IV to PO antibiotics include:
 Patient shows signs of clinical improvement with current IV therapy (decreased WBC, afebrile > 18 hrs, etc).
 Patient has been able to tolerate PO feeds/medication for the past 24 hours.
 Patient has had no nausea/vomiting for the past 24 hours.
 Patient is not receiving vasopressor therapy.
 Revised Guidelines for Cubicin, Zyvox, and Vancomycin
 Revision of Automatic Stop Order Dates on Antibiotics- consideration of shortening stop order dates and switching
from soft to hard stop
These issues will be formally brought back to the committee for vote at the next meeting.
For more information on any of the above issues and activities, please contact the Department of Pharmacy
(extension 4-2255).