P H A R M A G R A M 
...an educational memo from your Pharmacy and Therapeutics Committee
July, 2004
Nebulized Levalbuterol (Xopenex®) Formulary Restriction and Autosubstitution:
When levalbuterol nebulized solution was originally reviewed by the Pharmacy and Therapeutics Committee, it appeared that prescribing would be limited and, therefore physicians were not required to follow the usual procedure for requesting this non-formulary drug. However usage and costs have significantly escalated over the past several months. After a critical evaluation of the literature showing no greater clinical benefits or lowered risks with levalbuterol use compared to (racemic) albuterol, the Committee decided to restrict the use of this drug by providing an autosubstitution of levalbuterol to nebulized albuterol. Physicians wishing to use levalbuterol for adult patients will need to follow usual procedures of completing a Non-Formulary Request form and contacting the P&T Committee Chairman for approval. The procedure for pediatrics will not change, although an additional Drug Use Evaluation form will need to be completed at the time of prescribing.
Parenteral Pantoprazole (Protonix®) Reformulated and Administration Changes:
Parenteral pantoprazole has been available as a lyophilized powder, which once reconstituted required an inline filtered when administering as an intermittent IV infusion. This product has now been reformulated which eliminates the need for a filter. This product has also been approved for administration as a 2 minute IV push, which eliminates the need for a minibag.
Your Pharmacy and Therapeutics (P&T) Committee and the Drug Formulary:
The P&T Committee consists of 31 physicians and 8 members who represent support services and hospital administration. Maintenance of the Drug Formulary is among several areas of responsibility of this Committee. Physicians may request a drug to be added to the Formulary by completing a Formulary Addition Request form which is available from the Pharmacy Department or online at http://library.osfsaintfrancis.org/druginfo.asp. The Drug Analysis Work Group (DAWG) Subcommittee researches and reviews each drug request. Using a balanced scorecard approach which considers efficacy, safety, patient’s acceptance and cost, this Subcommittee makes recommendations to the P&T Committee for drug product approval, denial or removal. If judged by a patient’s physician to be clinically necessary, a one-time or one patient use of a non-Formulary product may be requested by the prescribing physician by completing a Non-Formulary Request form (available from the Pharmacy Department or at the online site listed above) and contacting the P&T Committee Chairman.
Who Wrote That Order?:
Handwriting has sometimes been the topic jokes, but when it comes to ordering procedures and drug therapy in healthcare, it could have life or death consequences. It is critically important for the people carrying out those orders to know who wrote them in case questions arise in interpretation. Unfortunately with the introduction of the new IDX computer system in October, dictation numbers won’t be listed in the system. However, clinicians will be assigned IDX identification numbers. Besides a signature, we need a way to clearly identify the person writing an order. We are asking for your suggestions and ideas in a poll.
What procedure would you like to see to identify persons writing orders?
1) Printing your name along with the signature, 2) Using a print stamp, 3) Using IDX identification number, or
4) Some other suggestion.
Give your choice by leaving a message with either Jerry Storm at 655-3489 or Ed Rainville at 655-7331.
ADE (Adverse Drug Event) Hotline: 655-6805
Drug Information Service – 655-2382 (Mon-Fri; 8am – 4pm)