pharmacy newsletter

1. VOLUME 2, 2014 PHARMACEUTICAL CARE DEPARTMENT
PHARMACY TIMES
Pharmacy and Therapeutic
Committee updates
Approved New Non Formulary Drugs
1. Fingolimod
First oral medication approved by the Food and Drug Administration (FDA) to modify disease activity in
multiple sclerosis (MS) .The medication is approved to reduce the frequency of relapses (also called
exacerbations or attacks) and to delay physical disability.
It's recommended by Pharmacy and Therapeutic Committee to be used as second line therapy.
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PHARMACY
SERVICES
- Clinical services
- Unit Dose
- Ambulatory services
- Informatics and
Technologies.
- Drug Information
- Pharmacy Research
- Pharmacy Quality.
- Stock Management
- Narcotic and Controlled
- Chemotherapy Unit.
- IV and PN unit
- Oncology Outpatient
STOCK MANAGEMENT
MANAGING
MEDICATION STOCK
AND SUPPLY IN KAMC
IV & PN UNIT
PATIENT SAFETY
FIRST
Drug Information new resource
you can freely access lexi-comp
drug database by using
http:lexi.online.com

2. VOLUME 2, 2014 PHARMACEUTICAL CARE DEPARTMENT
2. Teriflunomide
- Proprietary Name: Aubagio
- Therapeutic Class: Immunomodulators.
- MOA:Dihydroorotate ,Dehydrogenase Inhibitors - -
- Dosage :Once-daily pill 7 mg or 14 mg
- FDA Approved: 2012 for treatment of relapsing forms of multiple
sclerosis
Approved New Formulary Drugs
- Anidulafungin
- Dosage form: 100mg vial (Antifungal , Echinocandin).
- MOA: Anidulafungin inhibits the synthesis of β (1,3)-D-glucan, an
essential component of the cell wall of filamentous fungi CANDIDA
species.
‣ Anidulafungin is proven effective in critically ill patients
‣ Higher clinical response and survival rates and shorter hospital
stays.
‣ Had a better global response rate (81%) than fluconazole (62%) in
patient with infections due to albicans.
‣ Faster clearance of positive blood cultures.
‣ Anidulafungin had improved survival among ICU and organ
dysfunction patients compared with fluconazole;
‣ Anidulafungin has proven efficacy in selected non-neutropenic ICU
patients : 2 weeks post therapy, global response persisted at 56.7%
‣ Showed consistent efficacy across different ICU subpopulations,
across infection sites, and against different pathogens: more than
half (53.8%) of ICU patients with candidemia survived for at least
90days.
Guidelines
- Antibiotics Prophylaxis During Surgery
h"p://www.ashp.org/DocLibrary/BestPrac7ces/TGSurgery.aspx
- The Management of Pain, Agitation, and
Delirium in Adult Patients,In the Intensive
Care Unit
h"p://www.ashp.org/DocLibrary/BestPrac7ces/TGPAD.aspx
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New Added
Medications in
Medica Plus
!
• TETANUS IMMUNE
GLOBULIN, HUMAN, TIG
250 IU/1ML PRE. DISP.
SYR. CODE: 3570
• HEPATITIS B IMMUNE
GLOBULIN, HBIG 200
IU/1ML PRE. DISP. SYR.
CODE: 3571.
• CEFUROXIME 250 MG/
5ML SUSPENSION
• GENTAMICIN;
DEXAMETHASONE 3 MG;
1MG/ML E/E DROP (10
ML). CODE: 3574
• CALCIUM FOLINATE 10
MG/1ML VIAL (30 ML).
CODE: 3568.
• HYDROQUINONE 4 %
CREAM. CODE: 3572
• DOCETAXEL 20 MG/ML
VIAL. CODE: 3561.
• DOCETAXEL 80 MG/4ML
VIAL. CODE: 3562.
• DOBUTAMINE 250 MG/
250ML BAGS (IN 5%
DEXTROSE) CODE: 3563.
• DOPAMINE 200 MG/
250ML BAGS (IN 5%
DEXTROSE) CODE: 3564
• LEVOTHYROXINE 100 MCG
VIAL (PS). CODE : 3583
. TERIFLUNOMIDE 14 MG
TABLET , CODE 3615 .

3. VOLUME 2, 2014 PHARMACEUTICAL CARE DEPARTMENT
Prescribing for wrong patient
need to be stopped
Two patient identifiers at least should
be always used
Pharmacy launched
new clear reasons for
holding patient orders
‣ Therapeutic duplication
‣ Same order duplication
‣ Same medication duplication
‣ Exceeding max. dose
‣ Low dose
‣ Dose need adjustment
‣ Wrong medication
‣ Wrong frequency
‣ Wrong route
‣ Wrong duration
‣ Wrong infusion rate
‣ Wrong patient
‣ Prescribed without privileged
‣ Monitoring error
‣ Discrepancy error between
electronic and patient file
‣ No ID approval
‣ Drug-drug interaction
‣ Wrong entry
* These reported data can be
seen on the hold reason of the
electronic prescription on the
eMAR of medica plus (HIS).
Pa$ern
of
an*bio*c
prescrip*ons
for
OPD
and
ER
pa*ents
at
KAMC,
a
Ter*ary
Care
Center
in
Saudi
Arabia
Muna
Oqal1,
Soha
Aly
Elmorsy
,2Amal
AlEmy3,
Reham
Alhadhrami4,
Rawan
Ekram5,
Ib*hal
Althobai*6,
Sawsan
Ghoneamy7,
Objective:
To
evaluate
the
extent
and
pattern
of
antibiotic
prescription
in
the
Out-­‐Patients
Department
(OPD)
and
the
Emergency
Department
(ER)
of
King
Abdullah
Medical
City
(KAMC)
a
tertiary
care
center
in
Makkah,
Saudi
Arabia.
Results:
A
total
of
3872
an7microbial
prescrip7ons
were
iden7fied.
This
cons7tuted
16.2%
of
all
OPD
and
ER
prescrip7ons,
ten
percent
of
OPD
prescrip7ons
contain
an7bio7c
in
contrast
to
47%
of
ER
prescrip7ons.
More
than
50%
of
an7bio7c
prescrip7ons
were
not
associated
with
any
men7on
of
infec7on
on
the
database.
Co-­‐amoxiclav
and
fluoroquinolones
were
the
most
frequently
prescribed
an7bio7cs.
Conclusion:
the
overall
percentage
of
an7bio7c
prescrip7ons
in
the
OPD
and
the
ER
at
KAMC
are
acceptable
but
the
percentage
in
the
ER
far
exceeds
the
overall
rate.
The
ra7onal
and
guidelines
are
needed
for
prescribing
an7bio7cs
in
the
OPD
and
ER.
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4. VOLUME 2, 2014 PHARMACEUTICAL CARE DEPARTMENT
COMING SOON
The First Technology in the Middle East
Auto-carousel Technology in the Main Pharmacy in
KAMC
Minimizing Medication
Errors Project
Continuous Meeting
Pharmacy continues the
education of how to avoid
medication error by participating
on the weekly meeting of
different specialities . cardiac and
n e u r o l o g i s t s a n d o t h e r
specialities educated on how to
use some system features and
how to prescribe safe medication
order.
System Updates
- Physician should use order
notes more efficient as apart of
some order documentation.
- Formulary has been updated to
have minimum choices of
medication name during
ordering.
- EMPLOYEE category has been
added beside the patient name.
Alert By E-mail
Daily alert email should be sent
to the prescribers to alert them
in case of medication errors
reported . This email is part of
education and will include some
helpful data for how to avoid the
reported error.
Medication Safety Best Practice for
Hospitals 2014-15
!!
# Best Practice 1: dispense vinCRIStine ( and
other vincaalkaloids ) in mini bag of a compatible
solution and not in a syringe.
!
# Best Practice 2: (a)use a weekly dosage
regimen default for oral methotrexate . if
overridden to daily require a hard stop
verification of an appropriate oncologic
indication.
(b) provide patient education by a pharmacist for
all weekly oral methotrexate discharge orders.
!
# Best Practice 3: measure and express patient
weights in metrics unit only . ensure that scales
used for weighing patients are set and measure
only in metrics units .
!
# Best Practice 4: ensure that all oral liquids that
are not commercially available as unit dose
product are dispensed by the pharmacy in an
oral syringe .
!
# Best Practice 5: purchase oral liquids dosing
devices ( oral syringes/cups/droppers) that only
display the metric scale.
!
# Best Practice 6: eliminate glacial acetic acid
from all areas of hospital.
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5. VOLUME 2, 2014 PHARMACEUTICAL CARE DEPARTMENT
CHILDHOOD VACCINATION
DAY
Pharmacy participated on the activity of
childhood vaccination day which held on the
ambulatory care building . Two staff have taken
responsibilities to arrange our sharing on this
event , Muna Oqal and Ahlam Alamri . Visitors
were happy and asking a lot of questions and
they were thankful for our information, Muna
and Ahlam said."
UPDATES ON HIS
MEDICA PLUS
- IV order can be stopped by one
click on the medication name
then choose closed order
option in the left column of the
screen .
- Chemotherapy protocols can
be deleted in one time or you
can choose multi select for
many medication and you can
unselect whatever you need.
- Review of all history of
chemotherapy protocols can
be down easily through new
option in the upper screen of
the chemotherapy ordering
window .
- Maximum and minimum dose
alert are activated in the system
and system should make alert
for uncommon dose.
Warning! Dosing confusion with
colistimethate for injection.
The following recommendations should be considered for safety
reasons:
1. colistimethate for injection must ONLY be prescribed as colistin in
terms of base activity with dose range of 2.5 to 5 mg/kg/day in patients
with normal renal function. As per package insert, use ideal body weight
for obese patients. This total daily dose should be given in 2 to 4 divided
doses.
2. Dosage reduction in the setting of renal insufficiency is recommended
3. If the drug is ordered as “colistimethate” or “colistimethate sodium,”
the prescriber should be contacted to verify the dose in terms of colistin
base.
4. Consider restricting ordering to infectious disease specialists or
intensivists.
5. To prevent errors, pre-approved printed guidelines or computer order
sets should be made available with dosing only as colistin base. Include
adjustments for renal dysfunction.
6. Dose limits should be established with immediate investigation
required for doses outside hospital guidelines. Guidelines should define
any circumstances where dosing outside the 2.5 to 5 mg/kg/day range
may be appropriate.
7. Monitoring of renal function while receiving colistin is important to
detect signs of renal toxicity associated with colistin and the
appropriateness of dosage should be re-evaluated periodically while on
treatment.
Produced and Supervised by : Lina Attas Drug Information Unit
Designed and Directed by : Wesam Badran Informatics and Automation
!
Reviewed and Approved by Pharmacy Director:
Mohammed Alghanmi
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Special thanks in this edition to :
1- Khuram Shahzad 2- Rayan Felemban 3- Fatimah Ghidan 4- Muna Oqal
For any drug information please call the Drug Information Unit
Ext:10613 Please check http://online.lexi.com
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