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Following is a P and T Committee update (from the September 22nd meeting). Starting date for specific programs is 1 October 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 |
| acetaminophen IV (Ofirmev) | Formulary, Restricted |
Restricted to ICU/oncology related fever where other agents cannot be used. Also restricted to colo-rectal surgery cases and cases performed by Drs. Kirby and Engle involving manipulation of the colon. The Committee discussed further expansion of use within the institution, and will work with specific surgeons on developing a multimodal analgesia protocol that is intended to be used in a wide variety of surgery patients. |
| glycopyrrolate Liquid (Cuvposa) |
Formulary Therapeutic Interchange Approved for Adults |
Dispense as ordered in pediatric patients. Cupvosa will be interchanged to hyoscyamine liquid in adult patients needing a liquid unless no sub written. Use glycopyrrolate tablets if possible. |
| Non-formulary, not stocked. | Patient may use home supply. Defer initiation to outpatient setting. | |
| peramivir (Rapivab) | Formulary, not routinely stocked, Restricted to ID | Use limited to treatment of seasonal influenza in adult patients who are not candidates for inhaled zanamivir or oral/enteral oseltamivir due to documented oseltamivir resistant influenza, oseltamivir intolerance, malabsorption, GI stasis/obstruction, or GI bleeding. |
| praziquantel (Biltricide) | Non-formulary, not stocked | Removed from formulary due to low use. |
| Sulfadiazine | Non-formulary, not stocked | Removed from formulary due to low use and medication errors with the LA/SA drug sulfasalazine. |
| Influenza vaccine, quadrivalent (FluZone) | Formulary for 2015-2016 Flu Season | Trivalent vaccine is only available in multi-dose vials from hospital suppliers. Quadrivalent influenza vaccine was approved based on hospital contracts and availability of a ready-to-use syringe. |
| naloxegol (Movantik) |
Formulary, Restricted Automatic pharmacist discontinuation approved |
Restricted to treatment of opioid-induced constipation in adults with chronic non-cancer pain. When opiates are discontinued, naloxegol may automatically be discontinued by a pharmacist. |
| methylnaltrexone (Relistor) | Formulary, Restricted |
Previously restricted to opioid-induced constipation in patients with advanced illness who are receiving palliative care when response to laxative therapy has not been sufficient. Approved to expand restricted use to include the treatment of opioid induced constipation in adults with chronic non-cancer pain. |
| Carbapenem Shortage Restrictions |
Meropenem, impenem/cilastatin, doripenem – Formulary, Restricted to ID. Therapeutic Interchange approved. Ertapenem – Formulary |
There is currently a national shortage of both meropenem and imipenem/cilastatin (Primaxin). In order to conserve these drug supplies for critical situations, during the shortage period their use will be restricted to infectious disease specialists. If ordered by other prescribers, the carbapenem will be converted to an alternative broad spectrum antibiotic regimen providing similar coverage (specific regimen will depend on the situation). Effective September 24, 2015. |
| Albumin MUE Results |
MUE Project |
20% of 176 orders did not meet use criteria or were indeterminate. Follow-up efforts for improvement will focus on encouraging a trial of IV fluids prior to starting albumin, and not using albumin when the serum level is above a defined target level. |
| Basal / Bolus & Sliding Scale Insulin Protocol Update | Protocol Updates Approved | Removal of regular insulin. Automatic interchange of per protocol SSI orders for regular insulin to insulin lispro. Creation of new SSI Level: “Low Level.” |
| Clostridium difficile Infection Clinical Pathway Update | Clinical Pathway Update Approved |
Addition of treatment options for recurrent episodes of CDI: 1) pulse/taper PO vancomycin 10-week regimen or 2) Fidaxomicin. Informational document for Medical Staff. |
| Antibiotics: IV-to-PO | Policy Update Approved | If responding to treatment, antibiotics may be converted to PO after 48 hours of IV therapy. Previously 48 – 72 hours. |
| Pamidronate Intravenous | Pediatric Order Set | Approved, includes lab, dose, administration, and monitoring issues. |
|
Propofol and NMB Discontinuation at Extubation |
Policy Approved | Propofol and neuromuscular blocking agents may be removed from the electronic medical record by RN or PharmD at time of extubation or discontinuation of mechanical ventilation “per protocol.” |
| Insulin Dose Rounding - Pediatrics | Policy Approved | Age based dose rounding approved. |