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Appendix F: UWHC Guideline for Medication Route Interchange in Adult Patients Guideline developed by UWHC Center for Drug Policy Coordination: Lee Vermeulen, MS, RPh, FCCP, Director, Center for Drug Policy Last Revised by: Wendy Horton, PharmD, BCPS; Kerry Goldrosen, PharmD Approved by P&T: June 2009 Next Scheduled Review Date: June 2011 A. Background This guideline outlines the framework and clinical criteria to support the UWHC Medication Route Interchange Protocol. B. Criteria To initiate interchanges in the route of medication administration (from parenteral to enteral route, including administration via various feeding tubes), the pharmacist will assess for appropriateness based on the following criteria: 1.0 Parenteral to Enteral To initiate the parenteral to enteral interchange, which includes medications administered orally or via feeding tubes, the medication must be listed in Table 1. In addition, patients must meet all inclusion criteria and none of the exclusion criteria. 1.1 Inclusion Criteria 1.1.1 Patient must have a diet order and be tolerating either a clear liquid or more advanced diet or must be tolerating enteral tube feedings. 1.1.2 Patient must have the ability to adequately absorb medications via the enteral route. 1.2 Exclusion Criteria 1.2.1 Patient is unable to swallow, is strict NPO, or refuses oral medications. 1.2.2 Severe vomiting or diarrhea has been documented within the past 24 hours or patient has an acute condition that affects gastrointestinal absorption (i.e. gastrointestinal obstruction or bleed, severe diarrhea, ileus, severe vomiting or mucositis). 1.2.3 Patient is hemodynamically unstable (sustained heart rate >100 beats/minute, respiratory rate >24 breaths/minute, systolic blood pressure <90 mmHg or on vasopressors). 2.0 Enteral to Parenteral For a patient to be eligible for the enteral to parenteral interchange the medication must be listed in Table 1 and the patient must meet one or more of the following clinical criteria. 2.1 Inclusion Criteria 2.1.1 Patient is unable to tolerate oral medications and does not have a feeding tube in place. 2.1.2 Patient has an acute condition that affects gastrointestinal absorption (i.e. gastrointestinal obstruction or bleed, severe diarrhea, ileus, severe vomiting or mucositis). 2.1.3 Patient is nutritionally compromised and parenteral administration of medication (phenytoin, fluoroquinolones, etc) is clinically warranted to minimize the amount of time the enteral nutrition is interrupted. 2.1.4 Patient is hemodynamically unstable (sustained heart rate >100 beats/minute, respiratory rate >24 breaths/minute, systolic blood pressure <90 mmHg or on vasopressors). 2.1.5 Patient has had an NPO order for greater than two days. 2.1.6 Patient has failed a swallow study and does not have a feeding tube in place.