For patients who report a type I reaction to penicillin, the pharmacy will dispense a cephalosporin or carbapenem unless the patient has a documented negative skin test to penicillin or has been appropriately desensitized to the prescribed antibiotic.
If a patient has a documented allergy to pencillin and the severity of the reaction cannot be characterized, the pharmacy will notify the prescribing physician to determine if he/she wishes to proceed with administering the ß-lactam antibiotic in question. If the physician still wants to give the ß-lactam antibiotic, the pharmacy will dispense the prescribed ß-lactam antibiotic and the dispensing pharmacist will document the details of the physician contact in the pharmacy notes on the patient's profile. As approved by the Pharmacy and Therapeutics Committee, a sticker will be placed on the IV bag which states, "WARNING: In general, cephalosporins can be safely use in a pencillin-allergic patient. However, if a patient has had an immediate/ anaphylactic reaction to penicillin, cephalosporin use should be avoided if possible. "This sticker serves to alert the nurse to check the circumstances of the patient's reaction to penicillin and to monitor the patient for any reaction that may be related to the currently prescribed ß-lactam antibiotic.
Medication Reconciliation is the process of communicating a complete list of medications to the next provider of care. It is an interdisciplinary process between patient, physician, pharmacy and nursing designed to prevent potential medication events. Patient medications are to be reconciled on patient admission, transfer (including post-op), and discharge.
Pharmacy technicians interview patients on admission and place a home medication list into HealthSpan for the physician to reconcile. This list is also used at transfer and discharge to insure that the patient is receiving appropriate pharmacotherapy. This list must be kept accurate by all healthcare providers to reduce the chance of medication events.
All high risk medications will be reconciled within 4 hours of admission or a nurse will contact the patient’s physician to reconcile these medications.
Pharmacy to Dose
Physicians may request Pharmacy to dose and monitor gentamicin, tobramycin, amikacin and vancomycin for their patients. This order can be placed in HealthSpan by typing Pharmacy in the Order Entry field.
Meds Requiring Approval
Medications may be restricted by indication or by approval from certain physicians. Documentation of these requirements must be made in HealthSpan before the medication can be released by Pharmacy. Examples of medications
March 17, 2009