Pharmacists,

Due to some complications that have arisen, the pharmacy team, as well as Neurology, have decided to put a pause on the second verification process that we recently implemented with TNK. At 1pm today, IT will inactivate that process indefinitely. This may be something we revisit in the future. TNK will return to being verified like any other medication order. A pharmacist is still expected to respond to bedside on 1st and 2nd shift. Pharmacists are available and will respond if requested on 3rd shift. The NICU weekend specialist will respond on weekends if the ED2 is not there yet (the UB should verify the order while the NICU specialist responds). As requested, we will print out the TNK tipsheet and make it available for quick reference in the 5th floor offices (Nellie's desk and UB Supervisors' Office).

Expectations for TNK Verification: In an emergent situation, like a stroke alert, time is very important. The stroke team often spends most of the "fibrinolysis window" deciding whether to give TNK, so when pharmacy gets the order, it is often very close to the end of the window. In these situations, minutes count. The expectations for pharmacists when verifying these orders are 1) make sure it is ordered on the correct patient (does it match the stroke alert page, etc.) 2) verify dosing weights and calculate/check dose and 3) look for any obvious contraindications based on the available information. The verifying pharmacist is not, for example, expected to wait on imaging results in order to confirm absence of hemorrhage. Pharmacists cannot be held responsible for information that was not available to us during an emergency situation. In these situations, that burden is on the provider and stroke team at the bedside. 

Please reach out to me, Morgan, Alexis, or Gregg if you have any questions or concerns. 

Thanks,