Approved Hospital Formulary
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Approved Hospital Formulary
12/22/25 Duplicate PRNs - Product Notes
December 22, 2025
Pharmacists,
Tomorrow morning, PharmIT will apply the following Product Notes to the Cerner formulary products for each of the medications involved in the institutional standard sequence of administration. The three classes of medications that will be affected are constipation meds, anti-hypertensives, and anti-emetics.
If there are conflicting order comments (provider prefers a different sequence) leave the product notes as is and make sure order comments reflect the desired sequence ordered by the provider. We have decided NOT to have pharmacists delete out the product notes in case further orders are added or changed that would create confusion. Instead, nurses will be trained to 1) look at order comments to see which med should be given first and 2) if no order comments exist, click on the product note on the MAR and follow the sequence in the product note. Attached is a quick reference explaining how nurses can find the product notes on the MAR (not the MAR Summary), if you get questions from nursing. Please let me know if you have any questions.
See the product note wording below:
ADULTS ONLY: If multiple PRN constipation meds ordered, prioritize as follows, unless otherwise indicated by provider. If multiple routes of the same medication are ordered, use PO first unless NPO.
......1st option: senna/senna-docusate (Senokot-S)
......2nd option: polyethylene glycol (Miralax)
......3rd option: bisacodyl (Dulcolax)
......4th option: magnesium hydroxide (Milk of Magnesia)
......5th option: sorbitol
If desired effect not obtained or patient refuses, proceed to the next active PRN order in sequence. Preferred route sequence: PO-> PR
ADULTS ONLY: If multiple PRN anti-hypertensives ordered, prioritize as follows, unless otherwise specified by provider.
......1st option: clonidine (PO)
......2nd option: labetalol (IV) if clonidine ineffective after 30 mins AND HR >/= 60
......3rd option: hydralazine (IV) if labetalol ineffective after 30 mins OR clonidine ineffective AND HR < 60
ADULTS ONLY: If multiple PRN anti-emetics ordered, prioritize as follows, unless otherwise specified by provider. If multiple routes ordered for the same medication, use PO first unless NPO or actively vomiting.
......1st option: ondansetron (Zofran)
......2nd option: prochlorperazine (Compazine)
......3rd option: promethazine (Phenergan)
......4th option: metoclopramide (Reglan)
If desired effect not obtained, proceed to the next active PRN order in sequence. Preferred route sequence: PO->IV->PR->IM
Thanks,
Brian Boyett, Pharm. D.
Manager, Decentralized Pharmacy Services
Huntsville Hospital
Office: 256-265-4522
Office: 256-265-4522