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3/22/2021 lb Bye-Bye Banana Bag
March 22, 2021

From: "Lauren Butler" <lauren.butler@hhsys.org>
To: "Pharmacists" <grp_allpharm@hhsys.org>
Sent: Monday, March 22, 2021 12:36:38 PM
Subject: Bye-bye banana bag
Splitting from Banana Bag Tip Sheet

Good afternoon,

We will be removing the banana bag from the ordering process tomorrow, March 23rd, allowing only the individual components to be ordered through the new PowerPlan: HOSP Adult Thiamine Replacement Orders (Alcohol and Non-alcohol related). I have attached a tip sheet and included some of the information below: 

Step 1: Ordering

•   When you type “hosp thiamine” under Orders, you will see the appropriate PowerPlan appear: HOSP Adult Thiamine Replacement Orders (Alcohol and Non-alcohol related) 
•  If you type “banana bag” under Orders, you will see HOSP “Banana Bag” Orders which will also take you to the appropriate PowerPlan. 

Step 2: Determine Caine Criteria

•  The prescriber will determine if the patient is at high or low risk of developing Wernicke’s encephalopathy/Korsakoff syndrome based on Caine’s Criteria
• Dietary deficiencies
• Oculomotor abnormalities (ophthalmoplegia, nystagmus, gaze palsy)
• Cerebellar dysfunction (ataxia, unsteadiness, abnormalities of past pointing)
• Altered mental state/memory impairment

Step 3: Select appropriate thiamine regimen

• High risk: Meets ≥  2 of Caine’s Criteria
• Thiamine 400 mg IV q 8 hrs for 3 days, then 100 mg PO TID x 1 week, then 100 mg PO daily
• Low risk: Meets ≤ 1 of Caine’s Criteria
• Thiamine 100 mg PO daily
• When you select thiamine, folic acid and the multivitamin will automatically be selected.  If you only want thiamine, uncheck folic acid and multivitamin.  

The tip sheet will also be available on the Pulse page from 3/23 to 4/6.