Medications not yet evaluated by P&T are considered NON-FORMULARY . . . . . Always check 2 unique patient identifiers - NAME and DATE OF BIRTH - at every step! . . . . . Please be sure to document all clinical activities daily.
P & T Update Memo November 2016

Following is a P and T Committee update (from the November 22nd meeting). Starting date for specific programs is 1 Dec 2016, 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
sugammadex (Bridion) Formulary, Restricted

Use criteria

  1. If spontaneous recovery of twitch response has reached 1 to 2 PTC and there are no twitch responses to TOF stimulation (deep blockade);
  2. In intubated or extubated patients if patients cannot open their eyes, swallow, or raise their head and have T4/T1 ratio <0.9,  30 minutes after neostigmine/ glycopyrrolate administration
  3. As rescue therapy in a life-threatening “cannot intubate, cannot ventilate” situation when rocuronium or vecuronium was used, also includes use by ER physicians
  4. For operations terminated prematurely soon after profound depth of neuromuscular blockade has been induced
  5. For patients at high risk for prolonged neuromuscular blockade or complications due to prolonged neuromuscular blockade (e.g., pulmonary disease or neuromuscular disease)
  6. Contraindications to other reversal agents.   Implementation date to be announced.
nafcillin / oxacillin Update

nafcillin – Reclassified as the new Formulary Workhorse

 

oxacillin – Formulary, restricted

 

Therapeutic Interchange Updated

Orders for oxacillin will be automatically interchanged to nafcillin. 

Oxacillin remains on formulary, restricted to no substitution orders, but not routinely stocked. 

If drug shortage of either agent occurs, the alternative agent will be utilized.
nebivolol-valsartan (Byvalson)

Non-Formulary

Therapeutic Interchange Approved		 Dispense individual agents separately.
bromfenac ophthalmic solution (BromSite)

Non-Formulary

Therapeutic Interchange Approved		 Automatic interchange to ketorolac 0.5% ophthalmic solution.
Olopatadine Ophthalmic Soutions (Pazeo, Pataday, Patanol) Update

Patanol 0.1% (generic) – Formulary

Pataday 0.5% – Non-Formulary

Pazeo 0.7% –  Non-Formulary

 

Therapeutic Interchange Approved

Patanol generic 0.1% as the formulary workhorse for this formulation. 

Orders for Patanol and Pataday dosed once daily will be automatically interchanged to Patanol (generic) dosed twice a day.
Formoterol (Foradil) Discontinuation

Non-Formulary

 

Automatic Interchange Approved

Formoterol (Foradil) was the formulary workhorse agent for the inhaled long-acting β-blocker (LABA) class.

Orders for Foradil and the other 3 LABA inhalers currently available, indacaterol, olodaterol, and salmeterol, will be automatically inter-changed to albuterol nebulizations administered every 6 hours.

Patient may use own inhaler supply.
Docusate Liquid Update

Bacterial Contamination Information Updated

 

Docusate Liquid Available for Use

The FDA investigation associated with a multistate outbreak has identified the bacteria, Burkholderia cepacia in more than 10 lots of oral liquid docusate sodium manufactured by PharmaTech. 

The investigation also detected B. cepacia in the water system used to manufacture the product.

Health care professionals may resume normal use of oral liquid docusate sodium not manufactured by PharmaTech.

Liquid docusate sodium is now available for use throughout the Huntsville Hospital Health System.
Severe Sepsis Order Set Review Approved for use Order set reviewed and approved by multidisciplinary groups, order set use is planned in near future.
ADE Report – Sept/Oct Increased reporting noted Insulin was the drug associated with the most ADE reports , and also the most preventable reactions.
ISMP Report Information Only Included various LA/SA issues, danger of controlled substances left at bedside and fentanyl patches used in ED , guidelines for insulin pump use during hospitalization.

 

 

 

 

 

 

 

 

 

 

 

 






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