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
August, 2003
Providing Patients with Written Drug Information Daily Being Studied:
Through the University of Illinois College of Medicine, a study is underway to see if providing hospitalized patients written information about their medications will have some beneficial results. More specifically, the results being reviewed will include: 1) the feasibility of providing the information, 2) patient satisfaction,
3) patient medication knowledge, and 4) frequency of patients’ discussions with their health care providers regarding medications and adverse drug events.
Recognizing and Reporting Adverse Drug Events (ADE):
In order to prevent or, at least reduce, the number of undesirable drug side effects, it is very important that ALL health care providers report ADEs. An ADE HOTLINE (655-6805) is conveniently available for quickly filing a report. To help identify an ADE, Saint Francis Medical Center has adopted the World Health Organization’s list or ‘Triggers’ that would indicate an untoward drug side effect may have occurred. Listed below is a summary of those Triggers:
Drugs: Diphenhydramine (Benadryl®), vitamin K, flumazenil (Romazicon®, naloxone (Narcan®),
antiemetics, anti-diarrheals, or sodium polystyrene (Kayexalate®).
Laboratory Values: Glucose less than 50 mg/dl, PTT greater than 100 sec, INR greater than 6,
WBC less than 3000/mm, platelets less than 50,000/mm, positive C. difficile, rising serum creatinine.
Drug Levels: Digoxin greater than 2 ng/ml, Lidocaine greater than 5 mcg/ml, Gentamicin/Tobramycin peak
levels over 10 mcg/ml or trough levels over 2 mcg/ml, Amikacin peak levels over 30 mcg/ml or trough
levels over 15 mcg/ml, vancomycin trough levels over 15 mcg/ml, and Theophylline levels
over 20mcg/ml.
Miscellaneous: Oversedation, lethargy, falls, hypotension, rashes, abrupt medication stop, transfer to
higher level of care, and death of the patient,
Pharmacy INTERnet Website (http://library.osfsaintfrancis.org/druginfo.asp) :
An INTERnet website hosting the Saint Francis Medical Center Pharmacy has been established and can be accessed without a userid or password. The Formulary, Autosubstitution list, Drug Shortages and Alternatives, Formulary Addition Request and Non-Formulary Request Forms, PharmaGrams, FYDI Newsletters, Pharmacy Phone numbers and Pharmacy Grand Round programs are some of the items located at this site.
Pneumococcal Vaccine (Prevnar®) Abbreviated Vaccination Schedule Discontinued:
Now that the shortage of the pneumococcal conjugate vaccine, Prevnar®, has been alleviated, the recommended dosage schedule may be reinstituted. The CDC had recommended an abbreviated vaccination schedule during the shortage. The routine schedule is a dose at 2, 4, 6 and 12-15 months of age for all healthy infants and toddlers. A ‘catch-up’ schedule is provided for children who are incompletely vaccinated at www.cdc.gov.
Dosing Change with New Salmeterol (Serevent®) ‘Diskus’ Formulation:
The metered dose inhaler (MDI) for salmeterol has been discontinued by the manufacturer in favor of the more environmentally friendly Diskus product. However the amount of drug per puff has changed and patients could receive an excessive amount of drug if the directions for MDI are followed for the Diskus product. Salmeterol MDI contained 21 mcg/puff while the Diskus provides 50 mcg/inhalation, or more than twice the amount. Therefore, the usual adult dose for salmeterol Diskus should be 1(ONE) inhalation twice a day.