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IV to PO Switch Program

The Pharmacy and Therapeutics Committee has approved an IV to PO Medication Switch Program to reduce the use of parenteral therapy when not needed for patient care. This allows for increased patient comfort and reduces cost of care.  Pharmacists will switch the parenteral forms of select medications to their oral equivalents if the patient is tolerated oral diet and is receiving other oral medications.  Examples of medications in the IV to PO program include aziththromycin, ciprofloxacin, fluconazole, moxifloxacin, famotidine and linezolid, among others.  

Deep Sedation  

Physicians must be credentialed to administer deep sedation medications. In addition, a sufficient number of qualified personnel must be present during use of these medications to monitor the patient.  Contact Department/Section Chief, Medical Staff Support or Residency Director for additional information.  

Dose Optimization Program                                                                                                           

Dose Optimization is a program approved by the Pharmacy and Therapeutics Committee to standardize the dosing of commonly used antibiotics for adults and adolescent patients.  The ordered dosage and/or schedule will be changed per approved protocols by Pharmacy unless an approved exception to this change exists.  A physician may override this process by obtaining approval through the Antimicrobial Use Stewardship (AUSS) pager at 383-0387.  

Beta-lactam antibiotic use in allergic patients.

The Department of Pharmacy Services will follow specified guidelines for dispensing beta-lactam antibiotics to patients with penicillin allergies.  Pharmacists will make the dispensing determination based on the nature of the penicillin allergy and input from the patient's prescriber.

The admitting physician is responsible for taking a detailed allergy history from the patient or the patient's family when circumstances permit. This information should be documented in the physician notes (progress notes) section of the patient's chart.

The physician who prescribes a ß-lactam antibiotic for a patient with a documented penicillin allergy is responsible for noting the severity of the reaction with the order, i.e. rash, anaphylaxis, angioedema, etc.  If there is inadequate allergy information in the chart, then it is the responsibility of the prescribing physician to obtain this information.

For patients who report a rash or other non-type I reaction to penicillin, the pharmacy will dispense any cephalosporin, carbapenem or monobactam.  The dispensing pharmacist will document the type of reaction and the source of the information in the pharmacy notes on the patient's profile.

March 17, 2009

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