Approved Hospital Formulary
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Approved Hospital Formulary
7/11/22 gk TPN Labels
July 12, 2022
From: "Gregg Knowles" <gregg.knowles@hhsys.org>
To: "Pharmacists" <grp_allpharm@hhsys.org>
Sent: Monday, July 11, 2022 10:35:02 AM
Subject: TPN labels
To: "Pharmacists" <grp_allpharm@hhsys.org>
Sent: Monday, July 11, 2022 10:35:02 AM
Subject: TPN labels
To All,
A critical component of the TPN compounder in PSP is on backorder. This part is necessary to produce TPNs, has a 24 hr expiration once placed on the compounder, and is replaced daily. In order to conserve our remaining supply, the following TPN strategy is being implemented immediately. PSP will alternate late days and early days for setting up the compounder. This will allow us to use the valve (the critical component) for 2 TPN batches in a 24 hr period. Today is a late day, meaning the compounder will not begin preparing TPNs until the noon hour. This will not affect the ordering of TPNs today, it is business as usual. At the end of the day, PSP will keep the valve on the compounder and use it tomorrow in the morning. Tomorrow, Tuesday, July 12 will be an early day, meaning TPNs will be made in the morning and need to be completed by noon, when the valve expires. In order to have all TPNs completed by noon, TPN labels must be completed by 0900. On Wednesday, July 13, the process starts over with Wednesday being a late day, etc. This strategy applies to Main, W&C, and Madison.
I'm sending this notice out to all for a few reasons. First, it guarantees the notice gets out to everyone who has been trained in TPNs. Second, while we believe the personnel assigned to do TPNs on any given day will be able to complete them all by 0900, if for some reason we cannot, we have the ok to call on folks not assigned to do TPNs to help out. For example, a hybrid who is working a morning UB shift. Third, if we do need to recruit help, be prepared to cover for that help until they can return.
A few details:
- Attached is a calendar for the rest of July denoting early/late days. At least for the short term, I will be sending out an email on the day prior to early days, reminding everyone the next day is an early day. This email is today's notice that tomorrow, Tuesday, July 12 is an early day. I'll be sending out another on Wednesday. I will not be sending out reminders regarding late days.
- The backorder is supposed to end in mid-August, but you know how unreliable that can be. If we receive no more valves from the manufacturer, we have a 10 week supply with this conservation strategy. We are working on the plan in case we run out of valves entirely and will publish that when/if needed.
- On early days, if you receive a consult for a new TPN between the hours of 0900 and 1530, dispense a stock solution for that night. If it is after 1530, that is like any other day and make a judgement whether a stock solution is needed (usually not).
- On weekends, since Madison does not open until 0800, Main will be completing their TPNs for both Saturday and Sunday. Doing them both days was less complicated than saying Main would do their early day but not their late day. Given the skeleton crew on weekends, this is when we will be most vulnerable and possibly need to reach out to a TPN trained weekend first shift UB to help out.
If the plan is flawless and we've thought of everything, that will be a first. Don't hesitate to reply with questions/concerns.
Thank You in advance for helping us through this challenge.
Gregg