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6/20/22 aw Pharmacist education re: triptan order sentences
June 21, 2022
From: "April Williams" <april.williams@hhsys.org>
To: "Pharmacists" <grp_allpharm@hhsys.org>
Sent: Monday, June 20, 2022 1:54:32 PM
Subject: Pharmacist education re: triptan order sentences
Hi all,
Situation: Beginning this Wednesday (6/22/2022), all inpatient triptan order sentences for migraine treatment will be updated to a standard frequency of q24h PRN, with a comment stating that the dose may be repeated once in 24 hours.
Pharmacists: Any triptans ordered inpatient for migraine treatment should be entered/verified as q24h PRN – this is intended to prevent the nurse from administering multiple q2h doses within a 24-hour period.
Nursing: If the nurse needs to administer the 2nd dose within 24 hrs, s/he should remove the additional dose under the same order (as an additional dose in Pyxis). The nurse would just need to document the reason when alerted for the dose being ‘too soon’ (i.e. sooner than 24 hours) in Pyxis and Cerner.
Background: We recently had an error where a patient received 5 doses of zolmitriptan in 24 hours. Their home rizatriptan was entered on the home med list with a frequency of q2h PRN migraine, with special instructions that it could be repeated once in 2 hours, with a max of 20 mg in 24 hours; this was ordered to continue inpatient. However, the special instructions were lost when the rizatriptan was interchanged to zolmitriptan, leaving the nurse with an order for zolmitriptan available q2h PRN (which was then administered to the patient 5 times in 24 hours).
Assessment/Recommendation: After discussion on our Med Safety call, it was decided to ask Pharm IT to adjust the following –
- Add a comment to all inpatient triptan order sentences stating, “May repeat dose once in 2 hours if needed; Maximum of 2 doses in 24 hours.” (Exception: naratriptan, which may have a repeat dose in 4 hours, still with max of 2 doses in 24 hours – comment has been added by IT accordingly.)
- Make the frequency on all inpatient PRN Migraine triptan order sentences q24h PRN (note: does not apply to other indications. Ex. naratriptan has a po indication for the prevention of menstrual migraine with scheduled dosing – naratriptan po BID x 5 days)
TOC will also be documenting on home med history with q24h PRN frequency and including the max dosing comment.
Please let me know if you have any questions or concerns with this safety update.