Code Upgrade: Earliest Fill Date

With the upgrade on November 16^th, the ‘Earliest Fill Date’ field will be made available on all controlled prescriptions where previously it was only available on CII drugs. Using this field on a CIII-CV drug will cause the prescription to fail with a digital signature failure message sent back to the provider’s Message Center inbox or pool.

To mitigate the issue, we have added the note ‘(CII Only)’ to the field to help prompt providers that it should only be used on CII drugs.

After the NCPDP eRx uplift on December 9^th, this field will become fully functional for all controlled prescriptions and the note will be removed.

ACE Inhibitor Therapeutic Interchanges

ACE Inhibitor Therapeutic Interchange

Currently, when a medication is ordered that has an approved P&T Therapeutic Interchange, Pharmacy makes the change at verification. Cerner allows for the substitution to be visible to the provider before pharmacy verification.  UMC is trialing the functionality with the approved ACE Inhibitor Therapeutic Interchanges. Please see the attachment for the functionality and workflow.  This applies for inpatient medications only.

Antibiotic Time-Out

Attention Medical Staff:

Recently, it has been brought to the attention of the Antimicrobial Stewardship Committee that providers are uncertain of the utility for antibiotic time outs. We have made an effort to bring more meaning to these reminders.

The Centers for Disease Control and Prevention (CDC) recommends 5 core elements for a successful hospital antibiotic stewardship program one of which is “Action”.

An example of an “Action” is a systemic evaluation of ongoing treatment need after a set period of initial treatment also known as an “antibiotic time out”. At UMC these reminders or alerts fire for Level 1 and Level 2 restricted antimicrobials (see list below). There are two time outs, at 48-hours and 72-hours. The 48-hour antibiotic time out is a reminder through SmartZone (which is seen in a ribbon on the right hand side of PowerChart). However, if no modification is made to therapy at 48 hours then a 72-hour antibiotic time out will then fire on a close chart. This time out requires an action be taken by the provider before continuing. See below for examples of both.

48-Hour SmartZone Reminder:

Example: Carbapenem Alert

72-Hour PowerChart Actionable Alert:

Kind Regards-
The Antimicrobial Stewardship Program and Dr. Ragain, CMO

Tamiflu Dosing Reminder

Tamiflu (Oseltamivir) Dosing Reminder

Reminder per UMC Medication Management Team, Clinical IT

Upon review of the EHR dose-range checking alerts, there are still a significant amount of alerts firing in the EHR surrounding dose-range checking for Oseltamivir:

Per manufacturer and pharmacy recommendations, Tamiflu should be adjusted for renal impairment.

Flu Season is upon us and with so many providers prescribing Tamiflu, it is important to remember that this drug needs to be renally dosed.

Influenza Treatment

•  Adults with renal impairment (Moderate, CrCl greater than 30 up to 60 mL/min): 30 mg orally twice daily for 5 days
• Adults with renal impairment (Severe, CrCl greater than 10 up to 30 mL/min): 30 mg orally once daily for 5 days
• Adults with ESRD on hemodialysis (CrCl 10 mL/min or less): 30 mg orally immediately, then 30 mg after every hemodialysis cycle; treatment duration not to exceed 5 days from the time of the initial dose 
• Adults with ESRD on continuous ambulatory peritoneal dialysis (CrCl 10 mL/min or less): Single 30-mg oral dose immediately 
• Adults with ESRD not on dialysis, influenza treatment: Use not recommended

Influenza Prophylaxis

• Adults with renal impairment (Moderate, CrCl greater than 30 up to 60 mL/min): 30 mg orally once daily 
• Adults with renal impairment (Severe, CrCl greater than 10 up to 30 mL/min): 30 mg orally every other day
• Adults with ESRD on hemodialysis (CrCl 10 mL/min or less): 30 mg orally immediately, then 30 mg after alternate hemodialysis cycles 
• Adults with ESRD on continuous ambulatory peritoneal dialysis (CrCl 10 mL/min or less): 30 mg orally immediately, then 30 once weekly 
• Adults with ESRD not on dialysis, influenza prophylaxis: Use not recommended

Source: Micromedex

(Disclaimer: These are recommendations set forth by Micromedex and the manufacturers of Oseltamivir only; double check and use clinical judgment as it applies)