Pharmacy Things to Know

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Pharmacy verifies every order and presciption you place. They often catch mistakes. Be nice to them when they call you!

How to find magic mouthwash

You can search magic mouthwash under Diphenhyd – you may wish to spell out what he individual compound and the options ie with or without lidocane (villages only have it without lidocaine). Other ways to find it are to search for “FIRST” (the brand name) or “BLM” (the components Benadryl/lidocaine/maalox)

Thick it order—How to get more for family

Send a message to the case manager, who will give you the Certificate of Medical Necessity already filled out. If not available that day, find an experienced pediatrician to locate one for you.

"As Indicated" On Presciptions

Always order one time medications as "As Indicated" not "Once." (for example, epipens and Diastat.) If you order it "once," it is no longer an active medication, it will not show on patient discharge information and future providers will not be able to re-order. Any refills placed on "once" orders are not valid or active, thus will not be seen in pharmacy. If in the ED, the medication cannot be pulled from PickPoint for discharge meds.

Acute vs Maintenance

Discharge medications default to "Maintenance." All antibiotics and short term medications should be ordered as "acute." This will allow "acute" medications to "fall off" of the active medication list once the course is complete.

Retail Pharmacy

You can click on "Retail Pharmacy" in the the Electronic Health Record side menu to see if any medication refills exist and the last time it was refilled.

"per CHAM"

Do NOT use "per CHAM" during health aide visits. Enter the chart and order every medication on the PowerPlan proposed by the Health Aide unless mailing/hand carry from YKHC Main Pharmacy.

RMT IM medications

When giving IM medications to children over RMT, verify concentration of the medication they have and give the Health Aide the number of mg and mL you want them to give, especially for morphine and benzos. When writing instructions in the RMT addendum, put the mg and mL amount first, then in parentheses the mg/kg. If you put the mg/kg first, the Health Aide may accidentally misinterpret this as the dose (e.g. Dexamethasone vial 10mg/1mL 7mg or 0.7mL (0.6mg/kg) rather than Dexamethasone vial 10mg/1mL 0.6mg/kg (7mg or 0.7mL). ALWAYS VERIFY THE CONCENTRATION!

Multivitamins

If you are having difficulty finding this, type "Multiple" or "animal" in the prescription search.

Dosing Calculator

The dosing calculator is designed to round up. Pay attention to dosing once you click "apply standard dose," sometimes you will get 6.88mL. Please, change this to something reasonable. Medication syringes do not always mark one tenth, so consider rounding to 1/2 mL amounts.

Prescribing Augmentin and Septra

When prescribing Augmentin and Septra, EHR is unable to differentiate between the two drugs contained in the medication, thus mLs will not be calculated by EHR or printed on the prescription. When prescribing these two meds, free text number of mL into the "Special Instructions" box. Augmentin is dosed by Amoxicillin and Septra is dosed by Trimethoprim

Dosing Ranges

EHR is unable to have dosing ranges, therefore YKHC has set order sentences to specific doses (e.g. tylenol dosing in 10-15mg/kg and YKHC sentences are set at 15mg/kg). This can be changed manually to fall within the range.

Medication Dosing

Many resources provide dosing in weight per day (e.g. Amoxicillin 80-100mg/kg/day div BID). When ordering in EHR, make sure to calculate mg/kg/dose (e.g. Amoxicillin 45mg/kg/dose BID).

For Morbidly Obese Children

Consider using the ideal body weight or 90%ile for weight to dose per kilo medications.

Vancomycin vs Clindamcyin

Of note, our clinda usage rates are increasing. From 2017 to 2019, the MRSA sensitivity to clinda went from 99% to 91% on the antibiograms. Use clinda with caution, document why you’re using it, and know that ASP is tracking usage closely. (Resources: Antibiogram, Skin and Soft Tissue Infection YKHC Clinical Guideline, Antibiotic Stewardship Program (ASP))

Cefdinir

As of 2019, this medication has been available in the villages for the treatment of AOM in the setting of recurrence or Amoxicillin allergy. Studies show that over 85% of Amoxicillin Allergy reports are not true allergy and being labled Allergic to a pencillin increases mortality. Therefore, if you see a child for AOM with Amoxicillin Allergy listed, make sure to review and confirm if true allergy is present using the Amoxicillin Allergy YKHC Clinical Guideline.

Synagis

Every chronic pediatric patient under 24 months old is screened before RSV season starts for Synagis eligibility. The screening forms are placed in a communication note that is saved to the chart. If the patient is eligible, a problem is added to the Problem List and the administration is managed by Outpatient Pharmacists.

Pediatric Seizure Kit

These kits are in the ER and Peds NW Pyxis Machines. They contain:

  • midazolam 10mg/2mL
  • keppra
  • phenobarbital
  • dosing cards with enlarged screen shots from the pediatric critical care guide

These drugs were chosen because they do not require refrigeration (Ativan does) and thus can be all together in one place. You are free to use a different benzo, but make sure to ask for it by name and know that it is not included in the kit. NOTE: midazolam can be given intranasally even without an atomizer. Draw two syringes, 1/2 dose for each nostril. When administering, push plunger as fast and hard as possible to spray medication across largest mucosal surface area.

Continuous Albuterol

If you think a patient needs continuous albuterol, consult respiratory therapy. They do have equipment required in their stockroom. Of note, most patients requiring continuous albuterol require transfer to Anchorage.

Outside Hospital Discharge Medication Prescriptions

When taking a phone call about a patient being discharged or reviewing discharge notes from another hospital, update medication list with all new prescriptions. If the outside hospital is providing the initial supply, document in "note to pharmacy: do not fill until family calls for refills."


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