April 2007 Pharmagram

Auto-Substitution Changes:

Epoetin alpha (Epogen®, Procrit®) will no longer be substituted to darbepoetin alpha (Aranesp®).

Iron carbonyl (Feosol® caplets) may be substituted with ferrous gluconate tablets. Iron carbonyl has been unavailable from the manufacturer.

Formulary Deletion:

Aminoglutethimide (Cytadren®) was deleted from the Formulary due to lack of prescribing.

Readability of Medication Orders

A recent survey of the SFMC pharmacists showed only 10% could ‘frequently’ read the prescribers’ signatures and only 15% could read the dictation numbers. Twelve percent said they can ‘never’ read the signatures.

Readability of drug orders was better, however 29% responded by ‘sometimes’ they can read the orders.

To reduce errors, prescribers are encouraged to make sure their orders are legible. Also, please include a readable dictation number, so that you can be contacted with any questions.

Look Alike Injectable Products

As highlighted by the deaths of several infants reported from an Indiana hospital that resulted from a mix-up of injectable products, look-alike containers can result in the wrong drug being used. Our SFMC Pharmacy has been well aware of this possibility and has made purchasing decisions to minimize potential errors.

Examples of look-alike products that have been addressed:

metoprolol 5mg/5ml and acetylcysteine 20% 4ml

midazolam 5mg/5ml and furosemide 40mg/4ml

aminophylline 250mg/10ml and etomidate 40mg/20ml

phenobarbital 130mg/2ml tubex and morphine 2mg tubex

heparin 100 unit tubex and morphine 2mg tubex

Despite ongoing efforts to reduce confusing look-alike containers, the medical community is encouraged to READ all labels. Please report look-alike containers to the Pharmacy.

Despite these efforts, alternatives are not always available.

Please be alert to the following look-alike vials:

dexamethasone 10mg and heparin 100 units/ml