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Following is a P and T Committee update (from the January 24th meeting). Starting date for specific programs is 31 Jan 2017, unless otherwise noted. Please let me know if you have any questions or comments. Don’t forget to check the “New Drug Monitoring Spotlight” section of the website, which provides important monitoring information about newly approved drugs. Also, attached is the updated version of the “Not Stocked, Not Ordered” drug list with the new additions highlighted in red.
Below is the memo with links to the drug monographs, protocols, and formulary documents. Click to access the full P&T packet for this month, or here to access the P&T packet archive.
|
Drug or Drug Class |
Formulary Decision |
Comments |
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umeclidinium inhalation (Incruse Ellipta)
|
Non-Formulary. Adults: Automatic Interchange Approved
|
Automatic interchange to ipratropium nebulization 0.5 mg every 6 hours. Patient may use home supply if needed. |
|
glycopyrrolate inhalation (Seebri Neohaler)
|
Non-Formulary. Adults: Automatic Interchange Approved
|
Automatic interchange to ipratropium nebulization 0.5 mg every 6 hours. Patient may use home supply if needed. |
|
Non-Formulary. Adults: Automatic Interchange Approved
|
Automatic interchange to DuoNeb (albuterol 2.5 mg + ipratropium 0.5 mg) nebulization every 6 hours. Patient may use home supply if needed. |
|
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Non-Formulary. Adults: Automatic Interchange Approved
|
Automatic interchange to Duoneb (albuterol 2.5 mg + ipratropium 0.5 mg) nebulization every 6 hours. Patient may use home supply if needed. |
|
|
Non-Formulary. Automatic Interchange Approved. |
Interchange to insulin glargine (Lantus) on a 1:1 unit dosage ratio. |
|
|
Reclassified as Formulary, unrestricted. |
Updated to match our current institutional practices. |
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Non-Formulary. Adults: Automatic Interchange Approved
|
Reclassified due to low use and expiring product leading to drug waste. Automatically interchange to mesalamine at an equivalent dosage. |
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|
ergotamine & dihydroergotamine product updates |
DHE Injection: Formulary |
Injectable DHE and ergotamine sublingual tablets will remain formulary agents for this class. DHE nasal spray and combination ergotamine/caffeine tablets and suppositories will be non-formulary due to expiring stock and drug waste. The prescriber should be contacted to discuss alternatives if a non-formulary product is ordered. |
|
Discussed by High Impact Committee |
Deferred to next meeting |
|
|
Discussed by High Impact Committee |
Deferred to next meeting |
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|
Discussed by High Impact Committee |
Deferred to next meeting |
|
|
Adult Calcitonin Dose Rounding |
Approved |
Dosages for intramuscular calcitonin for the treatment of hypercalcemia in adults may be rounded to ensure appropriate dosing of the medication daily and prevent drug waste. |
| Adult Chemotherapy Dose Rounding Update | Policy Approved |
Adult infusion chemotherapy orders may be adjusted to the nearest vial size or ML within 5% of the originally ordered dose. This policy is only to be utilized in adult patients and does not apply to St. Jude patients. |
| Adult ICU Continuous Paralytic Order Set Update | Approved | Order set in use. |
| Adult Sedation, Analgesia, & Delirium Order Set Update | Approved | Propofol updated to allow continuation of current rate at transfer and to specify titration guidelines based on patient’s blood pressure. Order set in use. |
| Pediatric Taper and Titration Guidelines Updated | Approved | Blood pressure parameters for propofol; RNICU remains excluded from guideline. |
| Proton Pump Inhibitor Project – Discontinuation Post-ICU Discharge | Methods for Pilot Project Approved Pending IRB Approval |
The Committee approved the automatic discontinuation of PPIs after patient discharge from CCU2 (with CCU1 acting as control group). Pending further evaluation by IRB. Anticipated duration of pilot project: 2 months. |
| Post-Splenectomy Vaccine Orders Update |
Addition of Meningococcal Group B Vaccine Approved |
Bexsero was designated as the workhorse agent on the protocol. Trumenba is available for patients with latex allergy. The Committee previously approved these agents for the indicated patients. Also, Menactra replaced Menomune for patients over age 55. |
| formoterol (Foradil) Discontinuation – Interchange Update |
Non-Formulary Adults: Automatic Interchange |
Adults: Continue interchange to albuterol nebulization. Pediatrics: Contact MD to recommend ICS/LABA combination or discontinue formoterol order |
| nafcillin/oxacillin Interchange Update | nafcillin – Remains Formulary Workhorse |
Adults: continue 1:1 mg interchange. Pediatrics: automatic conversion of oxacillin to nafcillin using a dose appropriate for weight and indication. Contact of MD may be required to determine indication of use. |
| Pediatric Dose Standardization Update | Approved |
Pharmacy to stock acetaminophen 80 mg suppository allowing standard doses of 80 mg and 40 mg (1/2 supp.). A prednisolone 6 mg standard added. |