From: Michele Durda
To: Pharmacists
Sent: Thursday, January 4, 2018 11:18:30 AM
Subject: 7T Admissions Unit - Titration and IV Medication Use Guidelines (ADULT)
Attachment: Titration and Tapering Guidelines 1.3.18 DRAFT

I have received a several questions about the 7T Admissions Unit and its status relating to the use of restricted drugs.

I have confirmed with Victoria Donaldson (7T Nurse Manager) that 7T is classified as a general medical/surgical unit.  They do not have access to central telemetry monitoring.  They are only able to attach a patient to a bedside monitor that does not connect to any central monitoring (either at the nurses' station or the centralized telemetry monitoring department).  I have submitted the attached draft update to be approved at the next P&P Committee.  However, you may go ahead and begin to use these guidelines now.  They have been approved by the unit's manager.

Key points related to the Titration and IV Medication Use Guidelines (ADULT):

1.  In general, the locations of use for the drugs listed in these guidelines are followed.  However, exceptions can always be made when appropriate (such as a bed shortage, palliative care patients, etc.).  Generally, I recommend leaving it to the discretion of the Unit Director and/or Charge Nurse to approve an exception to these guidelines for a specific patient.

2.  In emergent situations, these medications may be used in any of these areas (under supervision of physician, NP/PA, or ACLS provider).

3.  Insulin infusions:  It appears there are some misconceptions about the location restrictions on insulin infusions.  Patients requiring frequent monitoring and dosage adjustments should be limited (in general) to ICUs.  PCV and Family Practice/Diabetes units may also monitor and adjust insulin infusions per protocol for patients.  All areas can care for a patient on an insulin infusion as long as the dosing is stable and blood glucose testing is required no more than q4h.  This generally applies to patients that have initially been stabilized in an ICU and require continued IV therapy. 

Please let me know if you have any questions.
Michele
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Michele Durda, Pharm.D.
Medication Safety/Drug Utilization Pharmacist