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Following is a P and T Committee update (from the August 25th meeting). Starting date for specific programs is 1 Sept 2015, 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 |
| Emollient Type Lotions | Formulary Interchange Program Approved. |
Lubriderm Lotion will be the formulary workhorse for this class of topicals. Nine other OTC lotion products were classified as non-formulary, not stocked and interchanged to Lubriderm. |
| Emollient Creams / Ointments / Jelly | Formulary Interchange Program Approved. |
Eucerin cream, Vaseline Jelly, and Aquaphor (Healing) Ointment are classified as formulary agents. Three other OTC products and 1 prescription product (Carmol-40) were classified as non-formulary, not stocked and interchanged to Eucerin cream. |
| Skin Protectants | Formulary Interchange Program Approved |
A and D Ointment, Desitin Ointment, and zinc oxide (utilized in compounding) are classified as formulary agents. Three other OTC products were classified as non-formulary, not stocked and interchanged to Desitin Ointment. |
| invermectin 1% Cream (Soolantra) | Non-formulary, not stocked. |
Patient may use home supply. Defer initiation to outpatient setting. |
| nivolumab (Opdivo) | Non-formulary, not stocked. |
Rare inpatient use expected. Defer use to outpatient setting. |
| sacubitril-valsartan (Entresto) | Formulary status. | Dispense as prescribed |
| cangrelor (Kengreal) | Formulary status. |
Injectable antiplatelet. Low use is expected, dispense as prescribed. |
| abciximab (ReoPro) | Non-formulary, not stocked. | Removed from formulary due to low use. |
| panobinostat (Farydak) | Non-formulary, not stocked. |
Rare use expected. Patient may use their own supply. Defer initiation to outpatient setting. |
| Pneumococcal Vaccine Update | Both vaccines remain formulary. | Nurse-driven pneumococcal vaccine protocol to be discontinued. Dispense both PCV 13 and PPSV 23 as ordered. The protocol change will be coordinated with influenza screening, to begin on September 15th, 2015. |
| oritavancin (Orbactiv) | Remains formulary, restricted to ID in outpatient setting. |
Expanded administration locations to the observation unit in the emergency department. Requires ID consultation. Physicians may send patients from outside clinics to Outpatient Medical to receive drug without ID approval. |
| Open Biome | Status Pending. | Currently moving through committee approvals to transition from an IRB study to a procedure that could be performed at Huntsville Hospital by Infectious Disease physicians. |
| T2 Biosystems - Candida |
Diagnostic Tool. Testing restricted to ID and Oncology. |
Positive result: Automatic initiation of anti-fungal therapy by AMT Pharmacist. Negative result: Continuation of anti-fungal therapy to be discussed on AMT rounds. |
| Insulin Drip on Regular Nursing Units |
Recommendation from P&T: Insulin drips on floor should require q2 hour blood glucose monitoring. Final decision pending. |
Recommendations to be presented to nursing committees. |
| Vancomycin Critical Levels MUE |
Vancomycin remains an automatic PKS consult for management. ID physicians may elect to manage own therapy. |
MUE showed process improvement opportunities in lab draw timing, monitoring, and dosing. Education to be provided to Phlebotomy, Nursing, Pharmacists and Physicians. Currently, two ID physicians have requested to manage their own regimens. |