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entered by the team in the progress notes.  Orders are entered if specifically requested.

Therapeutic Interchanges:

A therapeutic interchange or alternative is defined as the authorized dispensing of medications with different chemical structures that are expected to have similar therapeutic outcomes and adverse effects when administered in therapeutically equivalent doses.  This practice contributes to more appropriate, safer and cost effective care by encouraging the use of selected products that the institution's medical staff believes to be the most useful for patient care.

Orders for non-formulary medications in designated classes will be interchanged with the indicated formulary class representative using pre-approved dosing guidelines, unless otherwise indicated on the order by the physician.  If a patient is allergic to, has experienced an adverse reaction to or had a treatment failure to the interchange medication, an attending physician or fellow may override the interchange by entering Continue with Original Order when the Therapeutic Alternative screen displays.

Examples of medication classes that have therapeutic interchanges include proton pump inhibitors (PPI), H-2 receptor antagonists, vitamins, ACE inhibitors, ARBs, statins, topical products, and certain antimicrobials

Transfer Orders:

Transfer orders are required for a patient moving from one level of care to another and also upon transfer from Labor & Delivery and the Critical Care Units.  Transfer orders are also required following all surgical procedures with the exception of minor procedures.

Prescriptions for Residents and their Families:

Prescription medications may be purchased by residents for their immediate families (living in same household) at a discount at the Employee Pharmacy, phone 7-4311.

Adverse Reaction Reporting Form:

JCAHO Standards and PCMH policy require that all significant adverse drug reactions (ADR) be reported to the Pharmacy and Therapeutics Committee for evaluation.  An ADR is defined as: Any undesired effect of a drug that requires some action be taken (such as stopping drug therapy or treatment with another drug). This reporting process is non-punitive, and data is used for quality improvement.

Adverse Drug Reactions should be reported to Pharmacy for entering into the Patient Safety Net (PSN) system.  The Pharmacy and Therapeutics Committee will review these reports monthly and forward significant reports to the FDA.

March 17, 2009

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