medication study guide

DMC MEDICATION STUDY GUIDE

Welcome to Nursing at the Detroit Medical Center

CONTENT

Topics __Page #

1. Calculation Review 1

2. Safe Medication Delivery 13 Best Practices Key Issues in Medication Administration

3. Therapeutic Administration 19 Anticoagulation Anti-infective agents Diabetes management

4. References and Resources 21

Within the DMC, all nurses who work in adult areas of practice are required to take a written evaluation on medication and IV calculations within the first 2 weeks of orientation. The test is comprised of 20 questions related to medications, medication dosages and IV calculations.

A passing score of 80% is required. Your score will be the number of questions you answer correctly in the time allowed. Basic calculators may be used.

If a retest is necessary, it is scheduled before the end of the second week of orientation. It CANNOT be taken on the same day as the original test.

A reference list of available and helpful resources at the DMC has been prepared to assist you in your review.

Good Luck!

DMC Patient Care Services Education Department

Med study guide revised by DMC Educator Task Force 5/10

Calculation Review

ABBREVIATIONS:

q4hr - every four hours mg - milligramq8hr - every eight hours Gm - grambid - twice a day mL - milliliterstid - three times a day L - Literqid - four times a day gtts - dropsac - before meals mcg - microgramspc - after meals prn - whenever necessary

Note: bid, tid, qid administration times are not necessarily evenly spaced. Times are generally defined by hospital policy, e.g. qid might be 9 AM, 1 PM, 5 PM and 9 PM. Drugs ordered to be administered at regularly scheduled spaced times during each 24 hour period, e.g., q 4HR (9AM, 1 PM, 5 PM, 9 PM, 1 AM, and 5 AM). Note JC guidelines for abbreviations cited later in this document.

EQUIVALENTS:

1000 mg = 1 Gm 1 tsp = 5 mL1000 mL = 1 L 1 Tbsp = 15 mL1000 mcg = 1 mg 1 Ounce = 30 mL

CONVERSIONS:

Gm to mg

Multiple by 1000 or move decimal point 3 places to the right.

mg to Gm

Divide by 1000 or move decimal point 3 places to the left.

L to mL

Multiply by 1000

mL to L

Divide by 1000

mg to mcg

Multiply by 1000.

mcg to mg

Divide by 1000.

Kg to Lb

Multiply by 2.2 (Divide by 2.2 to convert Lb to Kg)

Med study guide revised by DMC Medication Exam Taskforce, 4/10

DOSAGE CALCULATIONS:

There are two basic methods for solving all dosage problems.

1. The first method uses the principles of common or decimal fractions. Used to solve dosage problems dealing with tablets, capsules, and suppositories.

Desire (dosage) = Quantity to be given Have (on hand)

Example: A medication order reads, “ASA 650 mg po. q 4hr prn for headaches”. ASA is available in tablets containing 325 mg.

D = 650 mg = 2 tablets X 325 mg

2. The second method uses the principles of ratios or proportions. This is particularly useful to solve problems dealing with liquid medications, either oral or injection. NOTE: Either of these two methods can be used to solve common medication calculation issues.

Desire Have

mg : mL = mg : mL

Example: A medication order reads, “Dilantin Suspension 100 mg p.o. t.i.d.” Dilantin liquid is available 125mg/5mL.

D H

mg : mL = mg : mL100 : X = 125 : 5

125 X = 500

X = 500= 125

X = 4 mL


CALCULATING FLOW RATES FOR IV DRIP INFUSIONS

Method 1

1. Take the total amount of the milliliters, e.g. 1000mL, which you are to give in a stated time period and divide by the number of hours, e.g., 8 hours. This gives the number of mLs to be given in one hour.

Give: 1000mL D5W q 8hr

1000mL = 125mL/hr 8hr

2. Divide the total number of milliliters, per hour, e.g. 125mL/hr, by 60 (the number of minutes in one hour). This gives the number of mLs to be given in one minute.

125mL = 2.1mL/min (Rounding off to the nearest tenth) 60min

3. Multiply the number of mLs to be given in one minute, e.g. 2.1mL/min, by the number of drops in 1mL for the IV tubing you are using. This gives the drip rate in the IV per minute. Example: Macro drip is 10drops/mL.

mL per minute X 10 drops/mL = drops/minute 2.1 X 10 = 21 drops per minute

ANSWER: The drip rate for the IV is regulated at 21 drops per minute to administer 1000mL of D5W q 8 hr using a macro drip IV tubing with a drop factor of 10 drops per minute.


IVPB ADMINISTRATION

Give Lasix 40 mg. IVPB q 6 hr. Administer in 50mL of 5% D5W. Run solution over 30 minutes using macro tubing (10gtts/mL)

Method 1

50mL = 1.7mL/min (Rounded off to the nearest tenth)30 min

ANSWER: 1.7mL /mL x 10gtts/mL = 17gtts/min

Method 2

Total volume x drip factor = drip rateTotal duration in minutes

(hours x 60 minutes)

Give: 1000mL D5W q 8hr (using regular tubing 10gtts/mL)

1000 x 10 = drip rate 10000 = 21 ANSWER: 21gtts/min8 x 60 480


Mini vs Macro: The Great Debate

Ever have trouble deciding which type of IV tubing to use or how to calculate mL/hour and drops per minute? Here are some simple guidelines:

1. To calculate mL/hr:

Total amount of IV fluid Length of time over which it is to infuse

Example: 250mL = 62mL 1000mL = 25mL = mL per hour 4 hours 1 hour 8 hours I hour

2. To decide whether or not to use micro (Pediatric) or macro (Adult) drip tubing using the following rule of thumb:

a. Use the Pediatric Microdrip tubing if IV is to infuse at 50mL/hr or less ( for example: KVO, q 24hr).

b. Use Adult Macrodrip tubing if IV is to infuse at 75mL/hr or greater (q 8hr, q 6hr, and q 4hr IVs)

3. To calculate drops/min: Amount of fluid to be infused in one hour (60 min) x drip factor = drop rate 60 minutes

a) Micro tubing relationship is 1:1. Whatever amount of fluid you want to infuse

each hour is the number of drops per minute. E.g. If you are to infuse 75mL per hour, you will infuse 75 drop per minute.

b) Macro tubing drop factor is 10 drops per mL. Short Cut: Since 10/60 cancels out to1/ 6, simply divide amount of fluid to be infused by 6 in order to give drops per minute. 125mL/ 6 = 20.8 or 21 drops per minute.

Be sure you look carefully at the tubing you’ve selected. If you accidentally use MACRO when you meant to use MICRO and you infuse at the rate for MICRO, patient will receive SIX TIMES as much fluid as they should have. Remember during a Code Blue/Emergency situation MACRODRIP tubing should be hung. Medicated drips should be placed on pumps. Remove saline lock devices (small bore extension sets, etc) during emergency situations. They make bolusing IV Fluids very difficult.


Calculating Heparin Dosages

Order is for 25,000units heparin in 250mL to run at 800 units per hour. How many mLs per hour will you regulate the IV?

You can set it up as a ratio and proportion. But first it’s always easier to simplify by reducing your fractions if possible.

25,000 units per 250mL reduces to 100 units per 1mL

Set up your ratio / proportion to solve for how many mLs will contain 800 units.

100 units 1mL 800 units: x mL

Multiply the means and the extremes (product of the inner numbers = the product of the outer numbers)

100 x = 800 x = 8 You will need to run 8mLs per hour

Calculating Lidocaine Drip Rate

Order is for 2 grams of lidocaine in 500mL to run at 2 mg per minute. How many mLs per hour will you regulate the IV?

Convert grams to mg by multiplying by 10002 x 1000 = 2000

Simplify 2000 mg per 500mL 2000 mg per 500mL reduces to 4 mg per mL

Set up your ratio / proportion to solve for how many mLs will contain 2 mg

4mg: 1mL 2 mg: x mL

Multiply the means and the extremes (product of the inner numbers = the product of the outer numbers)

2 = 4x x = 0.5 (one half) of a mL

Now how many mLs per hour is 0.5mL per minute? 0.5mL : 1 minute = x mL : 60 min

x = 30mLs Run the lidocaine at 30mLs per hour (30minidrips per min)


REFERENCE ONLY:

Calculating critical care dosages (Eg: Dopamine dosages (mLs per hour and mcg per kg per min.)

Patient Care Services Critical Care Educators teach a 5 step method which will work for calculating many meds including:

Mcg / kg / min (ex: dopamine, dobutamine)Mcg / min (ex: epinephrine, nitroglycerin) Mg / min (ex: lidocaine)Units / hour (ex: heparin)

Use only the steps which are necessary. For example if the medication is not ordered according to body weight, you can skip the step where you divide by kg.

I. Start with the concentration of mg / mL or grams / mL

II. Multiply by 1000 if you need to change mg to mcg or grams to mg(For example the concentration of dopamine might be 800 mg in 250mL and the final order is written in terms of mcg so you need to multiply by 1000 so that you will end up with mcg.)

III. Divide by 60 if you need to end up with a rate per minute or per hour.

IV. Divide by kg if ordered according to weight.

Above steps will give you a numerical constant for this patient at this kg weight and this drug concentration. What’s great about this is that if the order changes from 5 mcg/kg/min to 6 mcg/kg/min, you have already done the calculating, taking into amount the patient's weight, the concentration of the drug, and the time constant of 60 min per hour. You can use the numerical constant and plug it into the last step shown below.

V. Now decide: Do you need to know the dose or the rate? If you need to know the dose: Dose = mL / hour X numerical constant If you need to know the rate: Rate = Dose divided by numerical constant

Example: When you come on duty you find the dopamine 400 mg in 250 mL is running at 22mL/hour. The patient weighs 55 kg. You want to know how many mcg/kg/min this is:

i. Start with the concentration 400 mg 250mL

ii. Multiply by 1000 400 x 1000 = 1600250


iii. Divide by 60 1600 = 26.660

iv. Divide by weight 26.6 =0.4855

v. Need to know the dose, so multiply mL/hour by numerical constant, which is 0.48

22 x 0.48 = 10.5 Patient is receiving 10.5mcg/kg/min

Another example: The order is for dopamine to run at 5mcg/kg/min. The concentration is 800mg /500 mL. Patient weight is 70 kg.

i. Start with the concentration (mg / mL) 800500

ii. Multiply by 1000 (mcg / mg) 800 x 1000 = 1600 500

iii. Divide by 60 (min / hour) 1600 = 26.660

iv. Divide by weight (kg) 26.6 = 0.3870

v. Need to know the rate, so divide Dose ordered by the numerical constant, which is 0.38

5 = 13 Run the IV at 13mLs per hour 0.38

Alternate methods for calculating Dopamine:

To Find mcg/kg/min use this formula

mcg/mL x mL/hr60min/hr x kg of body weight = mcg/kg/min

To Find mL/hr use this formula

Dose mcg/kg/min x 60min/hr x body weightmcg/mL of solution = mL/hr


PRACTICE PROBLEMS: EQUIVALENTS

1. 0.25 Gm = mg 8. 2 L = mL

2. 0.4 Gm = mg 9. 0.4 mg = mcg

3. 2 GM = mg 10. 0.125 mg = mcg

4. 125 mg = Gm 11. 250 mcg = mg

5. 750 mg = Gm 12. 200 mcg = mg

6. 50 mg = Gm 13. 154 Lb = Kg

7. 250mL = L 14. 1.5 ounces = mL

Practice Problems: DOSAGE CALCULATIONS

1. The physician’s order reads: prochlorperazine (Compazine) 10mg IM stat. You have a 2mL pre-filled syringe, 5mg/mL. How many mLs will you administer? Answer:

2. How many capsules are necessary to administer diphenhydramine (Benadryl) 50 mg, from capsules labeled Benadryl 25mg? Answer:

3. Meperidine HCL (Demerol) 35mg IM q 4hr prn pain is ordered. The pre-filled cartridge- needle unit is labeled: Meperidine 50mg/mL. (Express your answer in a decimal fraction, i.e., ½ = 0.5)

What volume will you discard?Answer:

What volume will you administer? Answer:

4. Dexamethasone (Decadron) 1.5mg is ordered qid and is supplied by the pharmacy as 750 mcg scored tablets. How many tablet(s) would you prepare to comply with the physician’s order?Answer:


5. Digoxin (Lanoxin) elixir 0.125mg (p.o.) qam (daily) is ordered. You have been given Digoxin elixir 50mcg(0.05mg) per mL. What volume will you prepare?

Answer:

Practice Problems: IV CALCULATIONS AND IV MEDICATIONS

1. The physician’s order reads: 1000mL D5W with 20meq KCL every 12 hours. Calculate the drops/minute using macro drip tubing (10gtts/mL).

Answer:

2. The physician’s order reads: 1000mL D5W every 24 hours at a KVO (keep open rate). Calculate the drop rate using microdrip tubing (60gtts/mL) is used?

Answer:

3. The physician order reads: 500mL D5 and 0.33 Sodium Chloride, with 1 ampule of MVI every 24 hours. Calculate the drop rate per minute using micro drop tubing (60gtts/mL).

Answer:

4. The physician’s order reads: Ampicillin 500mg IVPB every 6 hours in 100mL D5W. The secondary administration rate delivers 10 gtts/mL.

a. Calculate the drop rate per minute administering the medication over 30 minutesAnswer:

b. Calculate the drop rate per minute administering the medication over 45 minutes.Answer:

5. 10% Fat Emulsion (Intralipids) 500mL is ordered daily at 1300. Calculate drops per minute, using tubing that is calibrated at 20gtts/mL. Infuse the “lipids” over 4 hours.Answer:

6. Your patient is to receive a unit of blood (350mL), using tubing that is calibrated at 10gtts/mL. How fast should you run it to complete the transfusion in 2 hours?

Answer:

7. Heparin 25,000 Units in 250mL is ordered at 1000 units per hour. How many mLs per hour will you run?

Answer:

8. Lidocaine 2grams in 250mL is ordered at 2mg per minute. How many mLs will you run per hour?

Answer:


Answer Key

EQUIVALENTSPage 9

DOSAGEPage 9

IV CALCULATIONS AND IV MEDICATIONSPage 10

1. 250 mg2. 400 mg3. 2000 mg4. 0.125 Gm5. 0.75 Gm6. 0.05 Gm7. 0.25 L8. 2000mL9. 400 mcg10. 125 mcg11. 0.25 mg12. 0.2 mg13. 70 Kg14. 45 mL

1. 2mL2. 2 capsules3. Discard: 0.3mL

administer: 0.7mL4. 2 tablets5. 2.5mL

1. 14 gtts/min2. 41 gtts/min3. 21 gtts/min4. A. 33 gtts/min B. 22 gtts/min5. 41 – 42 gtts/min6. 29 gtts/min7. 10 mL per hour 8. 15 mL per hour


Safe Medication Delivery

ABBREVIATIONS

The use of abbreviations is discouraged. Avoid the use of abbreviations for drug names and drug regimens. The following abbreviations / dose designations are considered dangerous and will

NOT be accepted on medication orders, MARs and on verbal/telephone orders. Safe abbreviations must be used throughout the ENTIRE patient medical record, not only for medication orders.

Information from the Joint Commission

In May 2005, The Joint Commission affirmed its “do not use” list of abbreviations. The list was originally created in 2004 by The Joint Commission as part of the requirements for meeting National Patient Safety Goal Requirement 2B (Standardize a list of abbreviations, acronyms and symbols that are not to be used throughout the organization)

For accreditation purposes, the official “do not use” list applies, at a minimum, to all orders and all medication-related documentation that is handwritten (including free-text computer entry) or on pre-printed forms. This requirement does not currently apply to preprogrammed health information technology systems (for example, electronic medical records or CPOE systems), but remains under consideration for the future. Organizations contemplating introduction or upgrade of such systems should strive to eliminate the use of dangerous abbreviations, acronyms, symbols, and dose designations from the software.

For more information see Facts about the Official "Do Not Use" List.


http://www.jointcommission.org/PatientSafety/DoNotUseList/facts_dnu.htm

OFFICIAL JOINT COMMISSION “DO NOT USE” LIST

Citation: http://www.jointcommission.org/NR/rdonlyres/2329F8F5-6EC5-4E21-B932-54B2B7D53F00/0/dnu_list.pdf


Medication Administration Information

THE 5 RIGHTS OF MEDICATION ADMINISTRATION INCLUDE:

1- GIVING THE RIGHT ROUTE

2- GIVING THE RIGHT DOSE

3- GIVING THE RIGHT DRUG

4- GIVING IT TO THE RIGHT PATIENT

5- GIVING IT AT THE RIGHT TIME

NOTE: SOME RESOURCES NOW CITE 10 RIGHTS OF MEDICATION ADMINISTRATION:1. RIGHT SAFETY MEASURES

2. RIGHT MEDICATION

3. RIGHT TIME FRAME

4. RIGHT DOSE AND STRENGTH

5. RIGHT ROUTE AND METHOD

6. RIGHT PATIENT

7. RIGHT OF PATIENT TO UNDERSTAND ALL MEDICATIONS

8. RIGHT OBSERVATIONS (ABOUT PATIENT RESPONSE TO MEDICATIONS)9. RIGHT INTERVENTIONS AND NOTIFICATIONS

10. RIGHT DOCUMENTATION

KEY ASPECTS OF MEDICATION ADMINISTRATION

1. Indication /Action2. Side Effects3. Associated Laboratory Tests4. Contraindications5. Antidotes6. Patient Teaching7. Nursing Interventions8. Drug Interactions (drug-drug, drug-food, drug-alcohol)9. Legal Aspects of Drug Administration10. Administration Techniques

BEST PRACTICES for Safe Medication Administration

DMC Medication Turn-Around times:

STAT ≤ 20 minutesNow ≤ 1 hourRoutine ≤ 4 hours


Confirmation of Identification:

Safe medication use necessitates the confirmation of identification—identification of patients and of medications. Medication errors are the most common type of medical error and contribute to 7000 deaths a year, with an estimated $3.5 million to treat drug-related injuries occurring in hospitals (IOM, 2006). How much time does it really take to confirm the patient identification and be certain about the medication being prescribed, prepared, dispensed and administered? The time taken to confirm all elements of identification may save a life. When in doubt, check it out!

Verbal and Telephone orders:

Read Back all verbal/telephone orders following receipt.Exercise precaution when transcribing any medication order.

Medication Reconciliation:

Medication reconciliation is the process of comparing a patient's medication orders to all of the medications that the patient has been taking. This reconciliation is done to avoid medication errors such as omissions, duplications, dosing errors, or drug interactions. It should be done at every transition of care in which new medications are ordered or existing orders are rewritten. Transitions in care include changes in setting, service, practitioner or level of care.

NPSG: Medication Reconciliation

This National Patient Safety Goal, “Selected Risk Points in Medication Reconciliation,”addresses significant risk points associated with maintaining and communicating patient’s medication information. The risk points include obtaining current medication information when the patient enters the hospital, comparing the patient’s current medications to any new medications ordered for the patient, and providing the patient with updated medication information when he or she leaves the hospital’s care.

This goal complements existing Joint Commission standards that currently addresscomponents of medication reconciliation, including, but not limited to,

The hospital plans its medication management processes. A pharmacist reviews the appropriateness of all medication orders for

medications to be dispensed in the hospital. The hospital safely administers medications. The hospital coordinates the patient’s care, treatment, and services

based on the patient’s needs. The hospital provides patient education and training based on each

patient’s needs and abilities.


Before the hospital discharges or transfers a patient, it informs and educates the patient about his or her follow-up care, treatment, and services.

When a patient is discharged or transferred, the hospital gives information about the care, treatment, and services provided to the patient to other service providers who will provide the patient with care, treatment, or services.

The hospital maintains complete and accurate medical records for each individual patient.

Drug Diversion

According to evidence, one out of 10 Healthcare workers have a drug addiction.

When you sign for wastage, you are responsible for checking: correct drug, correct amount and correct patient. By signing you are stating the above are correct.

Through awareness and knowledge of what to look for, you can help stop diversion and assist dependent co-workers. Be alert to changes in job performance, physical symptoms and behavior.

POLICIES ASSOCIATED WITH SAFE MEDICATION ADMINISTRATION

MED 121 Controlled Substances Management

Wasting Medication o Two licensed caregivers are required to waste a controlled substance;

one to waste and one to witness.o Wasted medication is documented on the CSDR or PMFS and the wasted

portion is to be disposed of according to nursing procedure 2PHA 301 Controlled Substances Proactive Diversion Monitoring

o Monthly PYXIS Controlled Substance Report o On a monthly basis, RN/LPN/MDA/CRNA PYXIS controlled substance high

user/waster reports are generated by the pharmacy department and sent to the respective nurse managers.

o The pharmacy department maintains a copy of these reports.

The nurse who is diverting drugs from the unit may...

Frequently volunteer to give medications. Medicate another nurse's patient. Use the maximum PRN dosage when other nurses use less, or the maximum

PRN dosage may always be used on one shift but not on another (the PRN medications afford the greatest opportunity for the nurse to supply his/her habit).

Have responsibility for patients who complain that the medication given on one Med study guide revised by DMC Medication Exam Taskforce, 4/10

shift is not as effective as the medication given on another shift; or, that the patient did not receive medication when the records indicate they did.

Have high narcotic usage and waste reported Work on a unit where PYXIS discrepancies occur more frequently. Frequently offer to help resolve narcotic discrepancies Have pinpoint pupils and/or shaky hands. Appear to be sleepy and/or hyper while on duty.

Signs and symptoms – job performance

Late to work Poor judgment Disorganization Blames others Commits errors Increased sick day usage Appears on the unit on days off Disregards standards of care and practice Unreasonable excuses for poor performance Confusion about the work schedule Frequent breaks or time away from the work area

Signs and symptoms – physical symptoms

GI upset Shakiness Difficulty with speech Inattentiveness Increased anxiety Watery Eyes Diarrhea Swollen hands Always cold Wears long sleeves/sweaters on hot days

Signs and symptoms – behavior changes Mood swings Suspiciousness Drowsiness at work Depression Unusual attendance patterns Defensiveness Over reaction to criticism Disappearance from unit after accessing drugs Telling lies or fabrication of the truth

Citation: Rick McCarty, Director Security Investigation/OP, 2010


Therapeutic Administration

Therapeutic Drug Monitoring

Definitions

Therapeutic Drug Monitoring (TDM): a means of monitoring drug levels in the blood. TDM is practical tool that can help the healthcare team provide effective and safe drug therapy in the patients who need medications.

Peak Level: drawn during the drug’s highest therapeutic concentrationTrough Level: drawn during the drug’s lowest therapeutic concentrationsRandom level: drawn during any point of the dosing interval

PurposeTDM is utilized to measure blood drug levels so that the most effective dosage can be determined, with toxicity prevented.

It is very important that the ACTUAL time of blood draw is documented for proper interpretation of the level.

Depending on the drug, it may be desirable to measure a peak and/or a trough and/or a random level.

TROUGH levels should be taken as close to the end of the dosing interval as possible. In other words, TROUGH levels are drawn immediately before the next dose is due.

PEAK levels are usually drawn 1 hour after the administration of the drug (e.g. gentamycin, tobramycin). However, the peak levels of some drugs may be several hours following drug administration (e.g. 4-8 hours after an oral dose of phenytoin). For these t ypes of medications, random levels are usually sufficient.

When drug levels are required, it is important that it is specifically defined whether a peak, trough or random level is needed. In addition, if not known, it is important to clarify any uncertainty regarding the timing of a desired level. Samples should be analyzed as soon as possible… so send them to the lab immediately after obtaining them.

DMC Policies2 MED 607 Therapeutic Drug Monitoring: Antimicrobials and Anticoagulants2 MED 607 Attachment 1 -- Therapeutic Drug Monitoring: Aminogycosides2 MED 607 Attachment 2 -- Therapeutic Drug Monitoring: Vancomycin in Adults 2 MED 607 Attachment 3 -- Therapeutic Drug Monitoring-Antimicrobials-Ordering of Laboratory Tests to Assess for Adverse Drug Events2 MED 607 Attachment 4 -- Therapeutic Drug Monitoring-Pediatric Dosing of Aminoglycosides2 MED 607 Attachment 5 -- Therapeutic Drug Monitoring-Pediatric Dosing of Vancomycin


http://intraweb/main_dmcinfo/policies/policystorage/2_MED_607_Attachment_5_--_Therapeutic_Drug_Monitoring-Pediatric_Dosing_of_Vancomycin_March_2010.doc

http://intraweb/main_dmcinfo/policies/policystorage/2_MED_607_Attachment_5_--_Therapeutic_Drug_Monitoring-Pediatric_Dosing_of_Vancomycin_March_2010.doc

http://intraweb/main_dmcinfo/policies/policystorage/2_MED_607_Attachment_4_--_Therapeutic_Drug_Monitoring-Peadiatric_Dosing_of_Aminoglycosides_March_2010.doc

http://intraweb/main_dmcinfo/policies/policystorage/2_MED_607_Attachment_4_--_Therapeutic_Drug_Monitoring-Peadiatric_Dosing_of_Aminoglycosides_March_2010.doc

http://intraweb/main_dmcinfo/policies/policystorage/2_MED_607_Attachment_3_--_Therapeutic_Drug_Monitoring-Antimicrobials-Ordering_of_Lab_Tests_to_Assess_for_Adverse_Drug_Events_Dec_2009.doc

http://intraweb/main_dmcinfo/policies/policystorage/2_MED_607_Attachment_3_--_Therapeutic_Drug_Monitoring-Antimicrobials-Ordering_of_Lab_Tests_to_Assess_for_Adverse_Drug_Events_Dec_2009.doc

http://intraweb/main_dmcinfo/policies/policystorage/2_MED_607_Attachment_2_--_Therapeutic_Drug_Monitoring-Vancomycin_in_Adults_Dec_2009.doc

http://intraweb/main_dmcinfo/policies/policystorage/2_MED_607_Attachment_1_--__Aminoglycosides_07-01-08.doc

DMC Guidelines Therapeutic Use of Anticoagulants in Adults and DMC Pediatric Anticoagulation Guidelines:

Go to Pharmacy Home web site: http://intraweb/default.aspx?ifsrc=/pharmweb/ Click on anticoagulation

Reason for Therapeutic Drug Monitoring

Anticoagulation therapy can be used for therapeutic treatment for a number of conditions, such as atrial fibrillation, deep vein thrombosis, pulmonary embolism, and mechanical heart valve implant. It is important to note that anticoagulation medications are more likely than others to cause harm due to complex dosing, insufficient monitoring, and inconsistent patient compliance.

Antimicrobial therapy is used in the treatment of infectious disease. Maintaining therapeutic drug levels will improve outcomes.

Glycemic Control -To Hold or Not to Hold Insulin

Do Not HoldInsulin Glargine (Lantus®)--BasalDo not hold long acting (basal) insulin even if the patient is NPO, nauseated, vomiting, going to OR, etc. It is safe to administer in these situations, it has no “peak”. It is meant to cover glucose produced between meals and during the night. If dosed appropriately, glargine does not cause hypoglycemia. Basal insulin is required by all patients with Type I diabetes at all times. Therefore, DO NOT HOLD IT! If blood sugars are consistently <90 mg/dL call the physician to adjust the dose.

Insulin Aspart (Novolog®)--Correction DosesDo not hold correction doses which are used to cover existing hyperglycemia regardless of nutrition status. Give as ordered per blood glucose result within 30 minutes of CBG test. As long as the patient is eating meals, it is appropriate to give both prandial and correction doses of insulin aspart as prescribed.

HoldAspart (Novolog®) Insulin--Prandial DosesMany patients have orders for scheduled meal time (prandial) doses of rapid acting insulin aspart. Hold or decrease this scheduled mealtime dose if the patient is not eating, NPO, nauseated or vomiting. Giving insulin aspart in this situation can cause hypoglycemia. Insulin aspart peaks quickly and is meant only to cover the increased glucose from food.

Contact the physician/LIP when holding any dose of insulin unless there is a specific order to hold the insulin.


http://intraweb/default.aspx?ifsrc=/pharmweb/%20

Citation: DMC Short and Sweet, a Publication of the DMC Glycemic Control Team, 6/10

MEDICATION GROUPS

It is most helpful to study medications in groups or classifications, rather than as single drugs. The medication groups REFERENCED ARE:

1. Anti-infective Drugs 2. Cardiovascular System Drugs3. Central Nervous System Drugs4. Gastrointestinal Drugs5. Hormonal Agents6. Agents for Fluid and Electrolyte Balance7. IV Fluid therapy and TPN 8. Medication Administration Techniques9. Miscellaneous10.Therapeutic Drug Monitoring

REFERENCE RESOURCES:

The following resources are available for additional information:

1. Links for micromedix or other pharmacy sources for finding medications.

http://dmc-micromedex/home/dispatch

DMC pharmacy website

(Intraweb → Pharmacy → Department of Pharmacy Services)

2. Links for patient education material, especially related to medications given

(Intraweb → Library → Patient and Family Education)

3. National Patient Safety Goals:

http://intraweb/default.aspx?ifsrc=/content.aspx?id=299&sid=1

(Intraweb → Quality and Safety → quality and safety resource center →

then regulatory)

4. Links to access DMC (or site specific) Policies :

http://intraweb/


http://intraweb/

http://intraweb/default.aspx?ifsrc=/content.aspx?id=299&sid=1

http://dmc-micromedex/home/dispatch

(Go to intraweb, click on the header 'Policies')

5. Other notable medication administration policies: 2MED 121 Controlled Substances Management2MED 500 EMR Medication: Order, Administration and Documentation2MED 501 Intravenous Push(IVP) Medication, Approval of2 MED 607 Therapeutic Drug Monitoring: Antimicrobials and Anticoagulants2MED 1004 Medication Administration by an LPN2PC 412 Pain Management: Epidural, Interplural or Nerve Block Infusion2 PC 413 Pain Management: Patient Controlled Analgesia (PCA)2 PC 563 Intravenous Piggyback Infusion

6. Non-DMC useful sites:

http://www.jointcommission.org/PatientSafety/DoNotUseList/


medication study guide

Documents

medication administration

medication order

medication dosages

tablets x

gm divide

qid administration times

spaced times

dosage calculations