link-Pharmacy Newsletter 052011 - St. Mary's Hospital

Pharmacy and Therapeutics Committee Actions
Kate Rotzenberg, PharmD
From the March 23rd meeting:
Formulary Status Changes
IV Acetaminophen (Ofirmev®) has
been added to formulary at St.
Mary’s Hospital. The full monograph
is available on St. Mary’s Intranet
through the Pharmacy link.
Ceftaroline (Teflaro®) has been
added to formulary at St. Mary’s Hospital,
restricted to use by Infectious
Disease. The full monograph is available
on St. Mary’s Intranet through
the Pharmacy link.
Dabigatran (Pradaxa®) has been
added to formulary at St. Mary’s Hospital
(Tier 2 Dean Health Plan). The
full monograph is available on St.
Mary’s Intranet through the Pharmacy
link. A 6 month medication use
evaluation will be conducted on prescribing
and outcomes and will be
presented at the September meeting.
Drug Class Reviews
Proton Pump Inhibitor Review—
Therapeutic interchange policy approved
for pantoprazole, in effect
May 2.
Nasal Steroid Review—A therapeutic
interchange is planned for the near
future pending input from OB and
ENT. This is a cost savings program
similar to the Qvar® substitution implemented
last year.
Policy Changes
Renal Dosing Policy updated for new
additions to formulary and clarify use
of high-dose piperacillin-tazobactam
Best Practice Alert was approved for
consideration of Hematology consult
when IV direct thrombin inhibitors
ordered
New policy approved for timing of
prophylactic enoxaparin to meet
SCIP measures and accommodate
planning invasive procedures. Order
sets to be updated.
Formulary Access on Intranet
Kate Rotzenberg, PharmD
A link to the formulary is now available on
St. Mary’s Intranet below the Pharmacy
link. This document is an Excel spreadsheet
arranged alphabetically by generic
drug name and contains 1,970 entries
based on inventory.
Included information:
Brand and generic drug name
Strength
Dosage form
To search the list, use ctrl-F (hold down
the Control key and type F) anywhere in
the document. A box will appear and the
user may search by any word contained
in the document. Less is more—type
only part of the drug name to avoid misspelling.
This will take the user to the first
entry that meets the search criteria, use
the arrow for each subsequent entry.
Non-formulary items, even if used frequently,
are not on this list.
Limitations of the current list:
Reflects what the pharmacy orders,
not necessarily what is prepared for
patient use
Does not identify drugs restricted to
specific prescribing groups
Cannot be grouped by drug class
Does not identify cost differences
Future versions of the formulary listing
may incorporate some of this information.
Fall Prevention: Helping Our Patients Walk the Line
Randi Stouffer, PharmD, MPH, BCPS, CGP
In 2002, the National Quality Forum declared
that patient death or disability
resulting from an in-hospital fall was a
"serious reportable event." In 2008,
Medicare stopped reimbursing hospitals
for the care provided to treat
the sequelae of such "never events," and
other insurers quickly followed CMS's
example. Given that a fall with injury
increases a patient's length of stay by 12
days, with over $4000 in increased costs
(Bates et al., 1995), hospitals have increased
their efforts to prevent patient
falls. At St Mary's, our patients sustain
more falls than the national average, but
are less often injured. Regardless of
injury, however, the cost per fall has been
estimated at $351 (Boswell et al., 2001).
The House-Wide Quality Improvement
committee has introduced measures to
reduce the fall rate, including interdisciplinary
fall huddles (including pharmacists)
after each patient fall on 4SW
and 5SW. While initial results indicate
that the fall huddles are creating a safer
environment, evidence is still accumulating
and the model is being fine-tuned
before house-wide roll-out.
The QI committee recognizes the demands
upon pharmacists' time, especially
during centralized hours, but the drugrelated
information and advice have been
valuable during fall huddles. It is hoped
that the advent of patient acuity scoring
will lead to a more proactive approach by
pharmacists, allowing intervention before
a fall occurs.
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Pharmacy Newsletter