P H A R M A G R A M
OSF Saint Francis Medical Center, Peoria, Illinois
...an educational memo from your Pharmacy and Therapeutics Committee
July, 2003
Parenteral Methylprednisolone (Solu Medrol®) in Short Supply until 2004:
The Pharmacy continues to experience critically low levels of parenteral methylprednisolone. Dexamethasone and oral methylprednisolone are currently the best corticosteroid alternatives available. Supplies of parenteral hydrocortisone (Solu Cortef®) are improving, but are also limited. Pharmacists have been authorized to substitute with dexamethasone, as approved by the P&T Committee, if there is no indication not to substitute on the order.
Abbreviations Policy:
The Joint Commission now requires healthcare facilities to develop a list of abbreviations that can lead to medication errors and to ensure that those abbreviations are never used when ordering medications. The following list of abbreviations to be avoided was approved by the P&T Committee and was based upon evidence that they have caused numerous medication errors here and nationwide.
1. Any medication name – Write out the complete name 2. “U” for units – Write out “units”
3.”µg” for micrograms – Use “mcg” or micrograms 4. Q.D. – Use daily or q24hrs
5. Q.O.D. – Write out every other day or use q48hrs 6. .5 (no leading zero) – Should be 0.5
7. 5.0 (trailing zero) – Should be 5 8. SC or SQ – Use “subq” or subcutaneous
9. ‘cc” – Use mls 10. AU, AS, AD – Write out ‘both ears,’ ‘left ear,’ ‘right ear
11. <, >, ≤, ≥ - Write out “less than,” greater than,’ ‘less than or equal to,’ ‘greater than or equal to’
Ceftriaxone (Rocephin®) Dose - Clarification:
The last PharmaGram discussed the dosing frequency for ceftriaxone, but was less clear on the usual dose. Ceftriaxone dosing for adults less than 65 years old is 2 gm IV q24hrs and, if older than 65 years,
1gm IV q24hrs is used. Treating CNS infections usually requires a ceftriaxone dose of 2gm IV q12hrs.
Formulary Additions:
The following drugs were added to the Formulary by the P&T Committee:
Fenofibrate (Lofibra®) – used for reducing triglyceride levels. Since this product is also available as Tricor,® an autosubstitution was approved by the Committee.
Tegaserod (Zelnorm®) – used for treatment of irritable bowel syndrome in women.
Other Formulary Changes:
Further Formulary changes approved by the P&T Committee:
Imipenem/cilastin (Primaxin®) was removed from the CHOI Formulary. The only approved use for this drug within this hospital is for treating pancreatic abscess in adults, which must be indicated with the order.
Ultracet® (Tramadol 37.5mg/acetaminophen 325mg) – autosubstitution approved to individual ingredients.
Lindane (Kwell®) lotion/shampoo was deleted from the Formulary due low usage and potential neurotoxicity.
Hydromorphone (Dilaudid®) PCA concentration will be changed from 0.5mg/ml to 1mg/ml to avoid possible errors and for consistency with OSF affiliated hospitals.
Promethazine (Phenergan®) 50mg/ml deleted because of occasional confusion with the 25mg/ml ampules.
New Adult Enteral Nutrition Products Added to the Formulary:
Some changes were made to the adult enteral nutrition formulary to be more cost effective and streamline the number of products. The new product line for adults will be:
Isocal HN (Standard) Ultracal (Standard w/ fiber) Deliver 2.0 (Concentrated)
Magnacal-Renal (Renal) Choice DM (Diabetic) Subdue (Semi-Elemental)
Vivonex Plus (Elemental) Impact (Trauma/Acute Stress) Impact w/ fiber