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11/4/24 Upcoming PeriOp/Surgery Powerplan Edits [Ancef/Vanco]: Monday, Nov 4th
November 4, 2024
Good morning, all,
I wanted to update you on changes that will be occurring today, November 4th, with surgical Powerplans. These include:
1) Changes to clinical notes in regards to appropriate use of cefazolin given patient allergy information
2) Changes to Powerplans with vancomycin split dosing to 1 single dose
The first update involves a change to the wording around when to select a beta-lactam alternative for surgical site prophylaxis. An alternative agent will now be recommended under the following phrase: "For prior delayed, severe Beta-lactam allergy* [e.g. severe skin reactions (SJS, TEN, DRESS) or organ damage (kidney, liver)]*Does not include immediate reactions such as anaphylaxis, angioedema, or hives. Beta-lactam = penicillins, cephalosporins, carbapenems". This change was based on an abundance of data supporting the safety of cefazolin in patients with beta-lactam allergies (exception: delayed, severe allergies) and increased risks associated with alternative agents. Approval of this change has been granted by the Surgical Committee, Infectious Diseases Subcommittee, and P&T Committee. PowerPlans affected can be found in the attached word document.
Additionally, Powerplans that include split doses of vancomycin will be changed to include a single dose. This change has been made in response to operational issues, which include patients not receiving the full dose within the recommended time frame and the ongoing fluid shortage. Powerplans affected can be found in the attached word document. Of note, Powerplans that have already been ordered, but are in a planned state, will not be affected.
Unless a provider specifically has vancomycin pre-selected in their Powerplan favorite, we believe they should not need to re-save their favorite based on our testing to date. The Ancef changes to the clinical note should not require a favorite to be resaved. Given this, we hope this will be a seamless transition.
Please let me know if you have any questions.
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Cefazolin Powerplans |
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CARD ICD Pacemaker Pre Procedure (v.2 - Production) CARD Left Atrial Appendage Closure Pre Procedure (v.2 - Production) CARD Percutaneous Transcatheter Closure of Paravalvular Leak PeriOp Phased (v.1 - Production) - Meds for PreOp/IntraOp- Paravalvular CARD THC Loop Recorder Implant Pre Procedure (v.2 - Production) CARD Transcatheter Mitral Valve Repair (TEER) Pre Procedure (v.1 - Production) CARD Transcatheter Valve Intervention Pre Procedure (v.1 - Production) CTSURG Thoracic Surgery PeriOp Phased (v.1 - Production) - Medications for PreOp/IntraOp- CTSURG CVSURG Cardiovascular Surgery PeriOp Phased (v.1 - Production) - Medications for PreOp/IntraOp- CVSURG ENDO Gastrostomy Tube Insertion Phased (v.2 - Production) - Meds for PreOp/IntraOp Gastro Tube ENT Maxillo-Facial PeriOp Phased EKM (v.4 - Production) - Pre-Op and Intra-Op Medications -ENT GENSURG Bariatric General PostOp (v.2 - Production) GENSURG Bariatric PeriOp Phased (v.2 - Production) - Medications for PreOp/IntraOp –Bariatric GENSURG Implant Procedure PeriOp Phased EKM (v.4 - Production) - PreOp & IntraOp Meds -Implant GENSURG GENSURG Periop Hospital Phased EKM (v.6 - Production) - Medications for PreOp/IntraOp- GENSURG GYN PeriOp Hospital Phased EKM (v.4 - Production) - Medications for Pre-Op and Intra-Op –GYN IRAD Abdominal Drain Placement EKM (v.2 - Production) - Pre-Op IRAD Ablation Kidney Phased (v.1 - Production) - Pre-Op IRAD Ablation Liver Phased (v.1 - Production) - Pre-Op IRAD Ablation Procedure Phased (v.1 - Production) - Post Procedure Ablation IRAD Ablation Procedure Phased (v.1 - Production) - Pre Procedure Ablation IRAD Arteriogram Orders Phased (v.2 - Production) - Pre Arteriogram Orders IRAD Aspira (v.1 - Production) - Pre-Op IRAD Cholecystostomy (v.1 - Production) - Pre-Op IRAD Dialysis Declot (v.1 - Production) - Pre-Op IRAD Dialysis Fistulagram Orders Phased (v.1 - Production) - Pre-Op IRAD DVT Thrombolysis Phased (v.1 - Production) - Pre-Op IRAD Fistula Creation (v.1 - Production) - Pre-Op IRAD Gastrostomy Tube Placement Phased (v.1 - Production) - Pre Procedure Gastrostomy Tube IRAD Pelvic / Gonadal Outpatient Procedure Orders Phased EKM (v.2 - Production) - Pre Procedure Pelvic / Gonadal IRAD Pelvic Drain Placement (v.1 - Production) - Pre-Op: IRAD Percutaneous Drain Insertion Orders Phased EKM (v.4 - Production) - Pre Percutaneous Drain Insertion Orders IRAD Percutaneous Tunneled Aspira Drain Orders Phased EKM (v.2 - Production) - Pre Percutaneous Tunneled Drain Orders IRAD Pulmonary Embolus Thrombolysis Phased (v.1 - Production) - IRAD Pulm Embolus Thromb - PRE Procedure IRAD TACE BLEMBO Phased (v.1 - Production) - Pre-Op IRAD Tips Orders Phased (v.1 - Production) - Pre-Op IRAD Uterine Artery Embolization Phased (v.1 - Production) - Pre Uterine Artery IRAD Varcicocele Orders Phased (v.1 - Production) - Pre-Op IRAD Vascular Access Device (v.1 - Production) - Pre-Op IRAD Vascular Access Device (VAD) Placement/Removal Orders Phased (v.1 - Production) - Pre Vascular (VAD) Placement/Removal IRAD Venogram Generic Phased (v.1 - Production) - Pre-Op IRAD Vertebral Augmentation Phased (v.1 - Production) - Pre-Op IRAD Vertebroplasty Procedure Phased (v.1 - Production) - Pre Procedure Vertebroplasty IRAD Y90 Treatment Phased (v.1 - Production) - Pre-Op
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NEUROSURG Major PeriOp Phased (v.3 - Production) - Medications for PreOp/IntraOp –Neurosurg NEUROSURG Minor PeriOp Phased (v.3 - Production) - Meds for PreOp/IntraOp-Neuro Mino NEUROSURG Routine Intracranial Pressure (ICP) (v.2 - Production): OB Cesarean Delivery Acute EKM (v.4 - Production) - Pre-op C-Section OB GBS Prophylaxis (v.5 - Production) OB Prophylactic Antibiotic Therapy for PPROM (v.2 - Production) ORTHO Elbow Replacement PostOp EKM (v.2 - Production) ORTHO Foot and Ankle PostOp EKM (v.2 - Production) ORTHO General MAJOR Periop Hospital Phased EKM (v.2 - Production) - Preoperative - ORTHO General MAJOR ORTHO General Periop Hospital Phased (v.3 - Production) - Medications for PreOp/IntraOp ORTHOGen ORTHO Hip Replacement PostOp EKM (v.2 - Production) ORTHO Ortho Spine Postop (v.1 - Production) ORTHO Shoulder Replacement PostOp EKM (v.2 - Production) ORTHO Spine PeriOp Hospital Phased (v.3 - Production) - Medications for Pre-Op & Intra-Op- Spine ORTHO Total Joint Periop Phased Orders EKM (v.3 - Production) - Medications PreOp/IntraOp -ORTHO Total ORTHO Trauma Post Op EKM (v.2 - Production) ORTHO Trauma PreOp Admission Orders EKM (v.3 - Production) PAIN Implantation PeriOp Phased (v.1 - Production) - Meds for PreOp/IntraOp - PAIN Implant PAIN Intraprocedural Meds (v.1 - Production) PEDENT Maxillo-Facial PeriOp Phased EKM (v.2 - Production) - Pre-Op and Intra-Op Medications – PEDENT PEDORTHO General PeriOp Phased EKM (v.3 - Production) - PreOp and IntraOp Medications PEDS Ortho PEDORTHO Trauma Admission EKM (v.2 - Production) PEDS PLASTICS PeriOp Phased (v.1 - Production) - PreOp and IntraOp Medications –PLASTICS PEDSURG General Surgery PeriOp Phased EKM (v.3 - Production) - PreOp and IntraOp Medications PEDS SURG PEDSURG General Surgery PostOp EKM (v.2 - Production) PEDSURG Pectus PostOp EKM (v.2 - Production) PEDURO Urology PeriOp Phased EKM (v.2 - Production) - Pre-Op and Intra-Op Medications – PEDURO PLASTICS PeriOp Phased (v.4 - Production) - PreOp and IntraOp Medications –PLASTICS PLASTICS PostOp Phased EKM (v.3 - Production) - PostOp Plastic Surgery VASCSURG Aortic Surgery PostOp (v.2 - Production) VASCSURG Carotid Endarterectomy PostOp (v.1 - Production) VASCSURG Endovascular Stent Graft Post Op (v.1 - Production) VASCSURG Lower Extremity Fem Pop Tib Bypass PostOp (v.1 - Production) VASCSURG Vascular Surgery PeriOp Phased (v.2 - Production) - Medication for PreOp & IntraOp -VASCSURG VASCSURG Vein Stripping Orders Post Op (v.2 - Production)
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Vancomycin Powerplans |
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VASCSURG Vascular Surgery PeriOp Phased URO Urology Periop Hospital Phased PLASTICS PeriOp Phased PAIN Implantation PeriOp Phased ORTHO Trauma PreOp Admission Orders ORTHO Total Joint Periop Phased Orders ORTHO Spine PeriOp Hospital Phased ORTHO General Periop Hospital Phased ORTHO General MAJOR Periop Hospital Phased |
NEUROSURG Minor PeriOp Phased NEUROSURG Major PeriOp Phased GENSURG Periop Hospital Phased GENSURG Implant Procedure PeriOp Phased GENSURG Bariatric PeriOp Phased ENT Maxillo-Facial PeriOp Phased
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Sincerely,
Evan Lawson, PharmD
PGY-2 Infectious Diseases Pharmacy Resident
Huntsville Hospital
Office: (256) 265-0018
evan.lawson@hhsys.org