Approved Formulary
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Sentri7/Quantifi Documentation Aids
Description: A collection of Sentri7 Templates - copy from here and paste into your documentation as needed.
Directions: click within any dotted-line box to copy the contents of the box to the Clipboard.
Vancomycin Intervention Documentation
Blank template built within initial intervention:
Blank template for Follow-up Vancomycin SCr Evaluation Documentation:
Blank template for Follow-up Vancomycin trough level evaluation/adjustment Documentation:
Blank template built within initial intervention:
Protocol: PHARMACY or NEPHROLOGY;
Indication: ***; Target Trough: ***;
Risk Factors: ***; Age/Sex: ***;
Ht: *** cm, TBW: *** kg, BMI: ***;
Baseline Labs: SCr: ***, CrCl: ***; WBC: ***;
RN draw?: ***; Other Abx: ***;
Half-life: ***;
Loading Dose: ***; Maintenance Dose: ***;
Trough due: ***
Indication: ***; Target Trough: ***;
Risk Factors: ***; Age/Sex: ***;
Ht: *** cm, TBW: *** kg, BMI: ***;
Baseline Labs: SCr: ***, CrCl: ***; WBC: ***;
RN draw?: ***; Other Abx: ***;
Half-life: ***;
Loading Dose: ***; Maintenance Dose: ***;
Trough due: ***
Blank template for Follow-up Vancomycin SCr Evaluation Documentation:
(Next trough due:) input date time (MM/DD HHMM)
Labs: SCr: ***, CrCl: ***; WBC: ***;
Microbiology data: ***;
Dose appropriate: ***; Continue current dose.
Labs: SCr: ***, CrCl: ***; WBC: ***;
Microbiology data: ***;
Dose appropriate: ***; Continue current dose.
Blank template for Follow-up Vancomycin trough level evaluation/adjustment Documentation:
(Next trough due:) input date time (MM/DD HHMM)
Labs: SCr: ***, CrCl: ***; WBC: ***;
Trough: ***;
Microbiology data: ***;
Continue current dose: ***/Dose adjustment made for: ***
Labs: SCr: ***, CrCl: ***; WBC: ***;
Trough: ***;
Microbiology data: ***;
Continue current dose: ***/Dose adjustment made for: ***
Aminoglycosides Intervention Documentation
Blank template built within initial intervention:
Blank template for Follow-up Aminoglycosides SCr evaluation Documentation:
Blank template for Follow-up Aminoglycosides level evaluation/adjustment Documentation:
Blank template built within initial intervention:
Protocol: PHARMACY (Traditional, Extended Interval or Synergy) or NEPHROLOGY;
Indication: ***; Target Peak: ***, Target Trough: ***;
Risk Factors: ***; Age/Sex: ***
Ht: *** cm, TBW: *** kg, IBW: ***, AdjBW: ***, BMI: ***;
Baseline Labs: SCr: ***, CrCl: ***; WBC: ***;
RN draw?: ***; Other Abx: ***;
Half-life: ***;
Dosing Wt: *** kg; Loading Dose: ***; Maintenance Dose: ***;
Level(s) due: ***
Indication: ***; Target Peak: ***, Target Trough: ***;
Risk Factors: ***; Age/Sex: ***
Ht: *** cm, TBW: *** kg, IBW: ***, AdjBW: ***, BMI: ***;
Baseline Labs: SCr: ***, CrCl: ***; WBC: ***;
RN draw?: ***; Other Abx: ***;
Half-life: ***;
Dosing Wt: *** kg; Loading Dose: ***; Maintenance Dose: ***;
Level(s) due: ***
Blank template for Follow-up Aminoglycosides SCr evaluation Documentation:
(Next level(s) due:) input date time(MM/DD HHMM)
Labs: SCr: ***, CrCl: ***; WBC: ***;
Microbiology data: ***;
Dose appropriate: ***; Continue current dose.
Labs: SCr: ***, CrCl: ***; WBC: ***;
Microbiology data: ***;
Dose appropriate: ***; Continue current dose.
Blank template for Follow-up Aminoglycosides level evaluation/adjustment Documentation:
(Next level(s) due:) input date time(MM/DD HHMM)
Labs: SCr: ***, CrCl: ***; WBC: ***;
Level: ***;
Microbiology data: ***;
Continue current dose: ***/Dose adjustment made for: ***
Labs: SCr: ***, CrCl: ***; WBC: ***;
Level: ***;
Microbiology data: ***;
Continue current dose: ***/Dose adjustment made for: ***
DOAC Initial Intervention Documentation
Comments:
Follow-up DOAC Documentation
Comments:
Comments:
H&P reviewed: ***
Indication: ***
Pertinent Hx/Complicating Conditions: ***
Home Medication: *** / Last dose: ***
Baseline Labs: HgB: ***, PLT: ***, SCr: ***, CrCl: ***
Dose appropriate: ***
RN draw?: ***
Current DDIs?: ***
Indication: ***
Pertinent Hx/Complicating Conditions: ***
Home Medication: *** / Last dose: ***
Baseline Labs: HgB: ***, PLT: ***, SCr: ***, CrCl: ***
Dose appropriate: ***
RN draw?: ***
Current DDIs?: ***
Follow-up DOAC Documentation
Comments:
Labs: HgB: ***, PLT: ***, SCr: ***, CrCl: ***
Dose appropriate: ***
Current DDIs?: ***
Dose appropriate: ***
Current DDIs?: ***
Renal dosing Documentation
Comments:
Comments:
Agent: *** / Dose: ***
CrCl: *** mL/min
Indication: ***
Dose appropriate: ***
CrCl: *** mL/min
Indication: ***
Dose appropriate: ***