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Transcript
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.