Medical Professional Publications

Pharmacy and Therapeutics Committee Updates

(From the September 2014 Issue of MedStat)

For more detailed information, contact Kimberly Novak at Kimberly.Novak@NationwideChildren.org.

The following actions were taken at the August 7 Pharmacy & Therapeutics Committee meeting.

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.

Non-action items:

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.

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