PHARMACY POLICY AND PROCEDURE MANUAL
St. Mary’s/Duluth Clinic Health System
Duluth, Minnesota
Policy No._______
DEPARTMENT:
SECTION:
SUBJECT:
Pharmacy
Pharmacy Practice
Vitamin K orders
PURPOSE:
To ensure that the safest and most effective route of vitamin K is utilized in the SMDC healthsystem when ordered
POLICY:
I.
II.
III.
IV.
Oral vitamin K is the preferred route of administration whenever it is possible.
All orders for intramuscular (excluding use in neonates) and subcutaneous vitamin K will be automatically
substituted by the pharmacy to oral vitamin K whenever possible.
All orders for intramuscular (excluding use in neonates) will be automatically substituted by the pharmacy to
subcutaneous vitamin K if patients CANNOT take oral.
All orders for intravenous vitamin K will be immediately dispensed and given via slow IV infusion.
PROCEDURE:
I.
II.
III.
IV.
V.
This policy applies to all hospital areas in the Saint Mary’s/Duluth Clinic Health System serviced by the Department
of Pharmacy.
Expectations of the pharmacist when they receive an order for intramuscular (excluding neonate use) and
subcutaneous vitamin K.
a. Pharmacist will review chart and/or consult with nursing personnel to determine if oral administration is
possible. Factors to consider:
 Patient is taking PO (clear liquids at minimum), or NG is usable, or feeding tube is usable
 No abnormal GI absorption (low aspiration risk, no need for bowel rest, no obstruction, no vomiting, no
continuous GI suction, no malabsorption syndrome)
b. If oral administration is possible, the pharmacist will dispense oral vitamin K in the same milligram strength of
the subcutaneous or IM order. The parenteral form of vitamin K will be used orally if needed for small doses
of vitamin K (i.e., 1 mg).
 Example: Pharmacist receives an order for Vitamin K 5 mg subcutaneous. Vitamin K 5 mg orally will be
substituted.
 Example: Pharmacist receives an order for Vitamin K 1 mg subcutaneous. Vitamin K 1 mg orally will be
substituted. The parenteral product will be administered orally in this situation
c. When this auto-substitution occurs, the pharmacist will write an order or call an order to the RN noting this
substitution has occurred on behalf of the pharmacy and therapeutics committee.
d. In the rare event the pharmacist receives an order for intramuscular and the oral route is not possible, the
pharmacist will dispense subcutaneous vitamin K in the same milligram strength of the subcutaneous or IM
order.
e. When this auto-substitution occurs, the pharmacist will write an order or call an order to the RN noting this
substitution has occurred on behalf of the pharmacy and therapeutics committee.
f. Orders for subcutaneous vitamin K WILL BE DISPENSED when the patient CANNOT take oral.
There will be no auto-substitution of IV vitamin K. When IV vitamin K is ordered, it will be dispensed in a 50 mL
piggyback to be given by slow IV infusion over 30 minutes.
All pharmacists and physicians should refer to the “SMDC Vitamin K-Warfarin Reversal Guidelines” for detailed
guidance on how to optimally dose and deliver vitamin K.
A physician can circumvent this policy at any time by writing “Dispense as written” or “DAW” in his vitamin K
orders.
PRIMARY AUTHOR: Michael Gulseth, Pharmacy Clinical Coordinator
EFFECTIVE DATE:
REVISED DATE(S):
REVIEWED DATE(S):