Approved Hospital Formulary
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Approved Hospital Formulary
4/11/23 gk Update to ADULT vancomycin progress note templates
April 18, 2023
From: "Gregg Knowles" <gregg.knowles@hhsys.org>
To: "Pharmacists" <grp_allpharm@hhsys.org>
Sent: Tuesday, April 11, 2023 8:10:35 AM
Subject: Update to ADULT vancomycin progress note templates
To: "Pharmacists" <grp_allpharm@hhsys.org>
Sent: Tuesday, April 11, 2023 8:10:35 AM
Subject: Update to ADULT vancomycin progress note templates
To all,
In an effort to improve PKS vancomycin management, some changes are being made to the ADULT vancomycin progress note templates. These changes will go into effect Wednesday morning, April12.
- Indication is no longer a free text field, but rather a dropdown. Let me know of indications that need to be added. Free-texting can still be done by backspacing over the dropdown arrow.
- If the indication is any kind of PNA, there is a second dropdown denoting the MRSA Nasal PCR status. In the illustration below, CAP is the indication and Nasal Swab Ordered is the PCR status. Other PCR options (not shown) in the dropdown include Nasal Swab positive, Nasal Swab negative, and the 4 reasons a Nasal Swab would not be indicated. The two illustrations thus far are indicative of what an initial note could look like. On Day2+, the dropdown fields will copy over and still be functional. If the indication or the PCR status changes, the dropdown fields can be updated.
If the indication is not PNA, the 'if pneumonia' dropdown can be left blank or deleted entirely.
If the PCR comes back negative, the dropdown should reflect this and the results of notifying the MD should be included in the progress note.
If the PCR comes back positive, no action is necessary other than denoting that in the dropdown.
Attached is a PNA MRSA Nasal PCR flyer explaining the test in more detail.
When notifying a prescriber of a negative PCR, you will get mixed responses. It just goes with the territory. Even those MDs who have pushed for PCR testing will sometimes continue the vanco with a negative test. But you will also have success in getting vancomycin discontinued. You are always doing the right thing by notifying the MD.
Another change to the vancomycin progress note involves the checklist.
- The current verbose checklist, found only on the vancoinitial template, has been deleted. Taking its place are more condensed versions added to every type of vancomycin template (see example below).
- The checklist will now populate below the second table and is a series of short phrases. Each phrase has a drop-down associated with it. The drop-down says 'done' for most, with some also including a 'not applicable' option.
- Completing the checklist is not required, but strongly encouraged.
- You may keep the checklist (completed or not) in the progress note or delete the checklist prior to signing. It is up to you.
- If the checklist remains in the note, it should not be copied over to the next day (that's why it is under the second table). Each days template will create a new checklist. The checklist for Day2+ is slightly different than for the initial note. Likewise, the checklist for the vancoDC, vancoAUC, and vancoTrough quicknotes are different from each other.
These changes will provide a checklist for those that like to have one, while also serving as reminder to others of common causes of RPh related vancomycin safety events.
There will be a transition period where the 'indication' and 'if pneumonia' dropdowns will not be on existing notes, only new-starts (since it originates on the initial note and copies forward from there). The checklist, however, will be on all notes starting Wednesday whether a new-start or a continuation of an existing note.
Let me know of any issues or ideas to further improve the vancomycin process.