Formulary Changes
Additions
Collagenase (Santyl) ointment is a sterile enzymatic debriding agent for use in chronic dermal ulcers and severely burned areas. ($35.83 per 15 gm tube)
Levetiracetam (Keppra) XR oral tablet is indicated for the treatment of myoclonic, partial, and tonic-clonic seizures. This is a product line extension to the immediate release tablet and injection formulations that are currently on formulary. ($2.58 per 500 mg tablet)
Romiplastim (Nplate) increases platelet production through binding and activation of the thrombopoietin receptor. It is used as a second line agent after failure of standard therapy in the treatment of Chronic Idiopathic Thrombocytopenic Purpura. It is restricted to those physician(s) who are legally registered with the company to order and administer the medication.
Sevelamer carbonate (Renvela) is a cationic polymer used to bind intestinal phosphate. ($1.65 per 800 mg tablet)
Triamcinolone Acetonide (Triesence) facilitates vitreous removal during vitrectomy surgery. ($199.68 – Inpatient;$101.38 – Outpatient)
Propoxyphene products have been removed from the formulary due to limited use and the decision by the FDA to recommend removal of all propoxyphene products from the market.
Papain containing products have been removed from the formulary because they are no longer being manufactured.
New Anticoagulation Safety Policy
In February, the Clinical Board approved a new Anticoagulation Safety Policy to be implemented in the hospital. This policy was the result of new Joint Commission National Patient Safety Goals that aim to reduce the likelihood of patient harm associated with anticoagulation therapy. The new policy affects the use of heparin, low molecular weight heparins, and warfarin. Highlights of the policy include:
- Indication for anticoagulation must be documented in the patient’s chart.
- All warfarin orders must have indication, duration of use, and INR range documented in the patient’s chart.
- A baseline INR should be obtained prior to patient receiving 1st dose of warfarin.
- All heparin products must have an order, including heparin flushes.
- All patients who receive warfarin while in the hospital must be educated prior to discharge. The Pharmacy Department is educating all patients on warfarin prior to discharge and documenting the education in the patient’s chart under patient education.
- Nurses should be checking the chart of any patient on warfarin and contacting pharmacy prior to discharge if the patient has not been educated.
Medication Error Prevention
The FDA now recommends that ceftriaxone and calcium-containing products may be used concomitantly in patients greater than 28 days of age.