...an educational memo from your Pharmacy and Therapeutics Committee

July, 2000

The Executive Committee approved a policy requiring Professional and House Staff to include their dictation number on all orders. Intended to ensure patient safety, this will improve communication between the Professional Staff and the staff of the Medical Center. Please write and sign all orders legibly and put your dictation number on the order.

The Pharmacy and Therapeutics Committee, and the Executive Committee of the Medical Staff asks all prescribers to spell out the word, "units" when writing orders. This effort is intended to reduce the chance for an adverse drug event or medication error. A recent review at OSF SFMC indicated that 44% of the medical staff writes out the word "units" instead of abbreviating it. Thanks to those prescribers who already comply with this request. Other prescribers are encouraged to begin this practice.

Eleven inhaled steroid products are currently available in the United States. They differ in several ways, including potency, frequency of administration and aerosol vehicle ("dry" or "wet"). Working with local pulmonary medicine specialists, the Committee has developed a policy to reduce the number of inhaled steroid products carried by the OSF SFMC inpatient pharmacy.

Spacers (holding chambers) are available from Respiratory Therapy for use with inhaled steroids. The Respiratory Therapists will also instruct patients or family members about the proper use of inhalers and spacer / holding chambers.

Stabilized patients receiving prescription and non-prescription drugs that are not on the formulary (including non-formulary inhaled steroids) as outpatients may receive their home medication if the prescriber orders it, and the patient signs a consent form.

fibrillation/flutter to normal sinus rhythm. If conversion is successful, the drug may be prescribed for maintenance of normal sinus rhythm, depending upon the duration and severity of the arrhythmia. Dofetilide may be pro-arrhythmic due to prolongation of the QTc interval. It should not be used if the QTc interval is greater than 440 – 500 msec. It interacts with several drugs (cimetidine, ketoconazole, megestrol, prochlorperazine, trimethoprim (alone or with sulfamethoxazole), or verapamil), increasing the probability of a QTc-associated torsades de pointes arrhythmia. Co-administration with drugs that prolong the QT interval and other antiarrhythmic agents (phenothiazines, cisapride, bepridil, tricyclic anti-depressants, and certain oral macrolides, class I or class III antiarrhythmics and amiodarone). Other antiarrhythmics should be withdrawn or monitored to document low serum concentrations before dofetilide is started. The usual dose is 500 mcg p.o. twice a day. In patients with renal failure, the dose is adjusted. Continuous EKG monitoring is required during the initial dosing of the drug and at least every three months for stable outpatients. The risk of drug-induced proarrhythmia can be reduced by utilization of a dosing algorithm. Physicians familiar with guidelines for dofetilide use and registered with Pfizer will control initial drug administration.

narcotic analgesic. Other forms of meperidine remain on the formulary.

to reduce colonic transit time and improve colonic compliance in female patients with irritable bowel syndrome. Patients receiving this drug as outpatients may continue to receive it in the hospital using the "home medication policy"