Download policy - KentuckyOne Health

Saint Joseph Hospital and Saint Joseph East
PHARMACY SERVICES
Policy/Procedure
TITLE:
Medications Administration Guidelines
SECTION: Inpatient Drug Distribution
SUPERSEDES:
CODE:
064-IDD-76B
064-IDD-76C
PURPOSE
Determine the patient care area where specified medications can be used. Specify the rates to which intravenous
medications can be titrated to in specified patient care areas. Specify monitoring required to safely use
medications in specified patient care areas.
POLICY
Medications will be administered in the appropriate areas, titrated to the appropriate doses and monitored
for safe use as specified as follows:
Medications (use is specified in attached table):
a. Abciximab
b. Alteplase (tPA)
c. Amiodarone (Cordarone)
d. Aminophylline
e. Argatroban
f. Bivalirudin (Angiomax)
g. Bumetanide (Bumex)
h. Conivaptan (Vaprisol)
i. Diltiazem (Cardizem)
j. Dobutamine
k. Dofetilide (Tikosyn)
l. Dopamine
m. Epoprostenol (Flolan)
n. Eptifibatide (Integrilin)
o. Esmolol (Brevibloc)
p. Fenoldopam (Corlopam)
q. Fentanyl
r. Furosemide (Lasix)
s. Haloperidol (Haldol)
t. Heparin
Issued: 7/08
Approved:
Reviewed:
u. Insulin (Regular Only)
v. Isoproterenol (Isuprel)
w. Lidocaine
x. Midazolam (Versed)
y. Milrinone (Primacor)
z. Morphine
aa. Neostigmine
bb. Nesiritide (Natrecor)
cc. Neuromuscular Blockers
dd. Nicardipine (Cardene)
ee. Nitroglycerin
ff. Norepinephrine (Levophed)
gg. Phenylephrine (Neosynephrine)
hh. Procainamide
ii. Propofol
jj. Retevase (rPA)
kk. Sodium Bicarbonate
ll. Sodium Chloride 3% Injection
mm. Sotalol
nn. Vasopressin
Revised: 10/11, 6/14
Director of Pharmacy
Page 1 of 4
TITLE: Medications with Restricted Practices Policy
Generic/Brand
Name
Abciximab
(Reopro)
Alteplase (tPA)
Unit Specific
CC/Telemetry
CC/Telemetry
(SEE PolicySTAT)
CODE: 064-IDD-76C
Therapeutic
Category
Platelet aggregation
inhibitor
Thrombolytic agent
Administration
Considerations
Monitor for bleeding
Consider bedrest:
Avoid invasive
procedures, establish
separate IV line
Whenever possible,
administer via central
venous catheter and
PVC tubing
Consider theophylline
levels
Drip titrated according
to target aPTT range
Amiodarone
(Cordarone)
CC/Telemetry - IV
Antiarrhythmic
Aminophylline
CC/Telemetry/MS
Bronchodilator
Argatroban
CC/Telemetry/MS
Anticoagulant
CC/Telemetry
Anticoagulant
CC/Telemetry/MS
Diuretic
CC (SEE PolicySTAT)
Vasopressin
antagonist
Diltiazem
(Cardizem)
CC/Telemetry
Calcium channel
blocker
Dobutamine
CC/Telemetry/MS
(SEE PolicySTAT) –Transfer
criteria from Telemetry to CC
Inotropic agent
Dofetilide
(Tikosyn)
CC/Telemetry - Initiation
CC/Telemetry/MS - Continuation
Antiarrhythmic
Agent, Class III
Dopamine
CC/Telemetry/MS
Vasopressor
0-5 mcg/kg/min nontitrating for Telemetry
and MS
Epoprostenol
(Flolan)
CC/Telemetry
Vasodilator and
platelet aggregation
inhibitor
Administer via central
catheter, cannot be
mixed with any other
medications
Eptifibatide
(Integrilin)
CC/Telemetry
Anti-platelet
Esmolol
(Brevibloc)
CC/Telemetry
Beta blocker for SVT
or Hypertension
Avoid use in small vein
or butterfly catheter d/t
thrombophlebitis
Fenoldopam
(Corlopam)
CC
Vasodilator
May D/C abruptly
without weaning
Fentanyl
CC/Telemetry/MS
Narcotic analgesic
Reversal agent- Narcan
CC/Telemetry/MS
Diuretic
CC/Telemetry/MS
Sedative
Monitor QTc q12hr if
receiving >32 mg/24 hr
Heparin
CC/Telemetry/MS
Anticoagulant
Reversal agent
Protamine
Insulin
(Regular Only)
CC – Critical Care or DKA Protocol
Telemetry/MS – Non-Critical
Care/DKA Protocol ONLY
Pancreatic hormone
100 units/100 mL
standard concentration
Bivalirudin
(Angiomax)
Bumetanide
(Bumex)
Conivaptan
(Vaprisol)
Furosemide
(Lasix)
Haloperidol
(Haldol)
CC=Critical Care
Comments
Central line only
Use Atropine for
symptomatic
bradycardia
0-5 mcg/kg/min nontitrating for Telemetry
and MS
Monitor PT/aPTT; Monitor neuro status &
vital signs: administration of drip in CC
only; post drug infusion may be
admitted to telemetry.
*Requires RN Witness*
Monitor for prolonged QT interval,
hypotension; bradycardia; N/V and
headache
Can cause cardiac dysrhythmias
Monitor for bleeding. Can cause FALSE
elevation of PT and INR.
Monitor for bleeding and
and monitor aPTT
Monitor for volume depletion, hypotension
and hypokalemia
VS & Neuro checks Q1H;
Na & K Q4H; Daily Digoxin
Monitor for hypotension, dysrhythmias
and heart rate. Telemetry max dose is
15 mg/hr
Monitor for hypotension and hypertension,
tachycardia, chest pain and PVCs
Baseline QTc required;
Monitor renal function/drug interactions
for possible dose changes
May wean to off; Regitine for
extravasations; Monitor IV site.
Telemetry max dose is 5 mcg/kg/min
Monitor for nausea, hypotension, sepsis,
headache & abdominal pain; if abruptly
withdrawn (including interruptions in drug
delivery) can cause rebound pulmonary
HTN, dyspnea, dizziness, or death
Monitor for bleeding, dizziness or nausea
Page 2 of 4
MS=Medical / Surgical
Monitor for BP and HR, contraindicated in
sinus bradycardia or heart block > 1st
degree
Monitor BP and HR, may cause
hypotension, bradycardia, chest pain and
T-Wave inversion
Monitor for respiratory depression and
hypotension
Monitor for volume depletion, hypotension
and hypokalemia
If administering > 32 mg/24 hr will require
placement in a monitored bed.
Monitor for bleeding
Monitor aPTT
*Requires RN Witness*
Observe for S/S of hypoglycemia.
Monitor blood glucose per protocol
*Requires RN Witness*
Reference: PolicySTAT
TITLE: Medications with Restricted Practices Policy
Generic/Brand
Name
Isoproterenol
(Isuprel)
Unit Specific
CC
Therapeutic
Category
β-1/β-2 agonist for
bradyarrhythmias
CODE: 064-IDD-76C
Administration
Considerations
1 mg/250 mL
Can mix in NS & D5W
Use cautiously in liver
patients and elderly
Lidocaine
CC/Telemetry
Antiarrhythmic
Midazolam
(Versed)
CC/ Telemetry
(MS – if under palliative care)
Benzodiazepine –
sedative
Milrinone
(Primacor)
CC
Vasodilator
Morphine
CC/Telemetry/MS
Narcotic analgesic
Neostigmine
CC/Telemetry
Acetylcholinesterase
inhibitor
Nesiritide
(Natrecor)
CC/Telemetry
Vasodilator
Neuromuscular
Blocker
CC
Paralytic
Nicardipine
(Cardene)
CC/Telemetry/MS
Calcium channel
blocker
Not compatible with LR,
sodium bicarb, heparin
or Lasix
Nitroglycerin
CC/Telemetry
Vasodilator/Nitrate
Special tubing required
α / β Agonist Vasopressor
Vasoconstrictor and
vasopressor
Central line ideal d/t
extravasation
Norepinephrine
(Levophed)
Phenylephrine
(Neosynephrine)
CC
CC
Incompatible with Lasix
Caution use in renal
patients
Reversal agent is
Narcan
Incompatible with
heparin
For continuous infusion,
should be titrated to
train of four
Monitor for dysrhythmias, chest pain and
blood pressure problems
Monitor for respiratory depression and
hypotension
Monitor for bradycardia – consider
atropine at bedside
Monitor blood pressure and urinary output
Must be combined with adequate
analgesia and sedation, ocular lubricant
needed
Monitor BP, HR and for chest pain,
flushing and dry mouth
If given peripherally, need 2 IV sites to
rotate drip Q12 hours
Monitor HR, BP, headache, syncope and
level of chest pain. Telemetry max dose
is 100mcg/min
Monitor HR, BP
Monitor for hypertension and arrhythmias
CC/Telemetry
Antiarrhythmic
Telemetry – Max dose
of 100 mcg/min
Propofol
CC
Sedative
Change IV tubing every
12 hours
Retavase (r-PA)
CC/Telemetry
Thrombolytic agent
Consider bedrest; avoid
invasive procedures,
establish 2 or more IV
sites prior to infusion
Sodium
Bicarbonate
CC/Telemetry/MS
Alkalinizing Agent
Refer to IV compatibility
chart
Sodium Chloride
3% (Hypertonic
Saline)
CC/Telemetry/ED
Electrolyte
Central line; electronic
infusion device required
Sotalol
(Betapace)
CC/Telemetry - Initiation
CC/Telemetry/MS - Continuation
Antiarrhythmic / Beta
Blocker
CC /
Telemetry - if not for vasopressor
use
Hormone;
Vasopressor; adjunct
for GI hemorrhage
and esophageal
varices, diabetes
insipidus
CC=Critical Care
Monitor for BP, HR and dysrhythmias
Monitor respiratory and cardiovascular
status
Procainamide
Vasopressin
Comments
Page 3 of 4
MS=Medical / Surgical
Monitor BP for hypotension, HR for
bradycardia, QT for prolongation and for
nausea
Can cause hypotension, triglyceride
check Q3days
Neuro checks q15min during infusion &
first 2 hours post infusion.
Administration of drip in CC only; post
drug infusion may be admitted to
telemetry
Monitor for hypokalemia and ABG’s for
metabolic alkalosis
Restrictions:
1. All physicians may order for patients in
ICU or monitored ED beds.
2. Only Nephrology and Pulmonary
Critical Care physicians may order in
Telemetry beds.
3. Prohibited in non-ICU Medical/Surgical
beds
Baseline QTc required;
Monitor Mg, K, and ECG for QTc
prolongation
Monitor BP; monitor for arrhythmias and
cardiac arrest
Reference: PolicySTAT