(From the September 2014 Issue of MedStat)
For more detailed information, contact Kimberly Novak at Kimberly.Novak@NationwideChildren.org.
The LPIP: Influenza Vaccine Employee to Employee Administration was APPROVED.
The LPIP: Initiating Diagnostic Testing on Emergency Department Patients was APPROVED with edits.
Clinic medication stock lists for Pulmonary, Sports Medicine East, and Colorectal were APPROVED.
A Medication Use Evaluation of Ciprodex® for Non-otic Use waspresented reviewing topical use in 57 unique patients with 97 inpatient medication orders between December 2011 and December 2013. During this time, 147 bottles of Ciprodex® otic suspension were dispensed for non-otic uses, correlating to $21,126.84 in acquisition costs. The most common documented rationale for use was tracheostomy site bleeding, followed by continuation of home medication, and granulation tissue with duration of treatment ranging from 1 to 35 days (mean 7.1 days). The majority of use was by ENT and Pulmonary Medicine. Substitution of two separate generic products, ciprofloxacin 0.3% ophthalmic drops and dexamethasone 0.1% ophthalmic drops, for the Ciprodex® otic suspension would have resulted in cost savings of approximately $19,700 during this time period. Recommendation: add an alternative therapy substitution pop-up alert in Epic directing prescribers to order ciprofloxacin 0.3% ophthalmic drops and dexamethasone 0.1% ophthalmic drops as an alternative to Ciprodex® otic suspension for inpatient non-otic use. This alert would not be a hard stop alert. The alternative therapy substitution alert was APPROVED. An audit of this alert will be brought back for P&T Committee review at a later date.
Six-month formulary reviews were presented for the following medications: palonosetron and duloxetine. Both were APPROVED for maintenance on formulary.
The combination HIV medication Emtricitabine and tenofovir (Truvada®) was APPROVED for formulary addition. Single agents products are already on formulary. The abbreviated monograph will be posted on the P&T intranet website. A review of formulary drug use will be presented in six months.
The updated policy PFC: XI-36:05 Controlled Substance: Accountability was APPROVED.
The new non-formulary IV drug card: Coagulation Factor IX (recombinant), Fc Fusion Protein (Alprolix®) IV drug card was APPROVED. It is now viewable in the online drug card database.
The updated IV drug card: Ketamine was presented but NOT approved. It will be discussed within a working group, edited, and brought back to the P&T Committee at a later date.
The 2nd Quarter 2014 Non-formulary Medication Use Report was presented for informational purposes.
The updated LPIP: RN Administration of Epinephrine for Anaphylaxis was presented for informational purposes due to minor wording edits by the Medical Executive Committee.
Plans for implementation of the LPIP: RN Administration of Ondansetron were clarified. Implementation is on hold pending resolution of two items: 1.) authorization by the Medical, Nursing, and Pharmacy Boards, and 2.) application of Epic alerts (BPAs, etc) for nurses entering verbal/per protocol orders.