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03/22/2017 MD -- Pharmacy Consult Process Updates
From: Michele Durda
To: Pharmacists
Sent: Wednesday, March 22, 2017 1:22:57 PM
Subject: Pharmacy Consult Process Updates
ATTACHMENTS
Pharmacy Consult List Management
As the new consult process has been rolled out, a couple of issues have been identified that require adjustment to the process. The attached Visio diagrams have been edited accordingly. These changes take effect immediately.
- Patient transfers (primarily affects "remote" transfers) See Pharmacy Consult List Management - Patient Transfers (page 2)
No matter time of day -
- Sending pharmacist contacts pager holder with transfer notice. 2. Sending pharmacist changes room number on Database. 3. Pager holder instructs Sending Pharmacist where to send information (tube, fax..) 4. Pager holder or Designee notifies Sending pharmacist IF FOLDER TRANSFER NOT RECEIVED. 5. Pager holder notifies Consult RPh of transfer or leaves in Central RX (with pager) for pickup as appropriate. ***If a face-to-face folder transfer occurs, the pager pharmacist does not need to be contacted; room number is updated in the database
- ED Vancomycin Order Set initiated by one RPh, but received for verification by a second RPh (due to coverage change) See Vancomycin Consult - ED (box - bottom right corner)
The ED Vancomycin Order Set was designed without a place for the nurse to document the pharmacist's name. This was intended to reduce the amount of information that the nurse would need to transcribe and simplify the communication process. This information was felt to be unnecessary because it would be documented when the pharmacist verified the scan of the order set via fax-back. The situation where the pharmacist performing fax-back would be different than the pharmacist dictating the order to the nurse was not anticipated. To prevent the need for re-educating nursing staff about documenting the pharmacist's name, the following process is recommended to accommodate this situation.
Verifying pharmacist:
* If dosing deemed appropriate - approve order via fax-back
* If dosing not deemed appropriate (choose one of the following):
- contact previous pharmacist to approve via fax-back
- reject order and contact nurse to adjust dosing
Please note that the vancomycin dosing ordered during the ED stay is not designed to be the "ideal" regimen. It is designed to increase the likelihood that the patient will receive his/her ordered doses (by making the doses available in PYXIS). The dosing regimen will only continue 12 to 48 hours max - usually only a dose or two before the patient is moved to an inpatient bed. The dose will be adjusted and monitored more closely when the patient is moved to a bed.
Bottom line: It is better to err on the side of higher dosing for the initial ED doses than under-dosing (if the patient is near a cut-off for dosing frequency).
Please let me know if you have any questions or concerns about these changes.
Thanks,
Michele
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Michele Durda, Pharm.D.
Medication Safety/Drug Utilization Pharmacist