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05/16/17 DC -- bicarb update

From: David Collette
To: Pharmacists
Sent: Tuesday, May 16, 2017 9:56:59 AM
Subject: bicarb update
 
I met with HH and medical staff leadership last evening to discuss the bicarb shortage. We have also been in communication with UAB and other facilities to determine if our actions are consistent. At the meeting last evening, the medical staff agreed with the following:

    * Bicarb should be removed from all crash carts and SHOULD NOT BE USED IN CODES. Several physicians spoke up to support this, saying that in many cases bicarb actually worsens survival. Dr. Squyers also said that it should rarely need to be used in the ED, maybe one amp in a trauma patient who has been down awhile and possibly in some overdoses.
    * The group concurred that we should do everything possible to keep a supply for our CABG patients. Dr. Washburn said that they would need at least 3 per case and would probably perform 200 cases by August. They were in support of sequestering 600 doses in Pharmacy for CV.
    * We must call on/investigate every patient who is ordered a bicarb drip to find out if they can take PO or have an NG placed.
    * Oncology is working to treat as many high-dose methotrexate patients with bicarb as possible
    * Jerry has worked on an orderset for vascular surgery that uses NS in place of a bicarb drip - this will save 3 doses per vascular patient.
    * If 1/10th strength Dakins or other topical product is ordered with bicarb, work with the physician to switch to a commercially available product.
    * Once I meet with physician leaders today, it MAY be decided that all bicarb will be removed from Pyxis - I will let you know.

Our goal is to have all of our plans finalized by Wed and communicate with the full medical staff and, of course, our Pharmacy staff.
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David R. Collette, Pharm.D., FASHP
Operations Manager, Professional Services Huntsville Hospital Department of Pharmacy