Results Issue #31
The following information is what has been received thus far from the surveys - May 01, 1997.
Please note in the drug evaluation section, and patient information sheets
people's name have not been included only the drug information centre.
1: The following centres substitute cefazolin and metronidazole for:
cefotetan
The Moncton Hospital
Hamilton HSC, Chedoke-McMaster Campus (MD called and changed)
Victoria General Hospital, Victoria (1gm or 2gm when prescribed for surgical
prophylaxis gets switched to Metronidazole 500 mg/Cefazolin 1gm)
cefoxitin
Royal Alexandra Hosp, Edmonton
Ottawa Civic Hospital, Ottawa (when used for surgical prophylaxis)
Calgary General Hospital, Calgary
Ottawa General Hospital, Ottawa
QEII Health Sciences Centre, Halifax
The Moncton Hospital
2: The following centres have a policy regarding the length of post-op
prophylaxis:
Hamilton HSC, Chedoke-McMaster Campus (policy just approved, to start May
1997)
QEII Health Sciences Centre, Halifax (no policy but DUE pharmacist reviews)
Royal Victoria Hospital, Montreal (protocol made with surgeons and published
as a guide and call physicians when prescriptions written for longer period)
Victoria General Hospital, Victoria (we have official guidelines for surgical
prophylaxis as we use prepared order sheets for most surgeries & these
list the recommended antibiotics for prophylaxis)
Kingston General Hospital, Kingston (liaison pharmacist responsible for
enforcing if > 24 hours ordered)
The Hospital For Sick Children, Toronto (recommended in Antimicrobial
Guidelines, order sets. Not enforced. Most procedures < or = 24 hours
3: Eprex is given to patients prior to, or after major surgery at:
Royal University Hospital, Saskatchewan (patient required to pay)
Sunnybrook Hospital, Toronto (patient required to pay - Janssen Ortho has a
program called Guideline [1-800-850-0552] to assist patients with
payment)
The Hospital for Sick Children, Toronto (occasionally)
Hamilton HSC, Chedoke-McMaster Campus (rarely used, patient required to pay)
4: The following DI centres receive e-mail regarding questions from:
other health care professionals
Royal Alexandra Hospital, Edmonton
St Joseph's Health Centre, Toronto
Children's Hospital of Eastern Ontario, Ottawa
Hamilton HSC, Chedoke-McMaster Campus
Victoria General Hospital, Victoria
B.C. Childrens Hospital, Vancouver
Dial Access, Saskatchewan (rarely)
Kitchener-Waterloo Health Centre, Kitchener
DPIC, Vancouver (discourage use due to insufficient background
information)
Mount Sinai Hospital, Toronto
Ottawa General Hospital, Ottawa
QEII Health Sciences Centre, Halifax
The Hospital for Sick Children, Toronto
School of Pharmacy DIC, St John's
Health Sciences Centre, Winnipeg
Calgary General Hospital, Calgary
the public
Mount Sinai Hospital, Toronto
Hamilton HSC, Chedoke-McMaster Campus (occasionally)
5: HCl or NaOH is used to clear catheter occlusions at:
Royal Alexandra Hospital, Edmonton (NaHCO3, HCl, procedure established)
QEII Health Sciences Centre, Halifax (HCl 0.1N occasionally, policy established)
Sunnybrook Hospital, Toronto (HCl, policy established)
The Hospital for Sick Children, Toronto (HCl, policy established)
Children's Hospital of Eastern Ontario, Ottawa (HCl)
6: These centres convert patients from Serevent to Ventolin if they are admitted
without their puffer from home.
Children's Hospital of Eastern Ontario, Ottawa
Ottawa Civic Hospital, Ottawa (try to get family member to bring in, if not
discuss with MD as to which product to use)
Kitchener-Waterloo Health Centre, Kitchener (require MD approval)
Mount Sinai Hospital, Toronto
Ottawa General Hospital, Ottawa
Toronto East General Hospital, Toronto (depends - may be asked to bring
in if MD doesn't approve of a switch)
Cite de la Sante de Laval, Laval
Hamilton HSC, Chedoke-McMaster Campus (will try to switch if used for more
than a few days)
7: Crystallized trypsin for inhalation is used at:
Mount Sinai Hospital, Toronto
8: Computer programs are used to classify journal articles in the following DI
centres:
The Moncton Hospital (ASHP program)
DPIC, Vancouver (homemade, used to index journal articles and indication
of review, versus guidelines...)
Ottawa General Hospital, Ottawa (vendor - askSam from florida)
QEII Health Sciences Centre, Halifax (homemade)
Cite de la Sante de Laval, Laval (homemade)
Clarke Institute, Toronto (homemade)
9: Hypertonic saline for inhalation is used at:
Children's Hospital of Eastern Ontario, Ottawa
Misericordia Hospital, Winnipeg
Royal University Hospital, Saskatchewan
Kitchener-Waterloo Health Centre, Kitchener
Calgary General Hospital, Calgary
Mount Sinai Hospital, Toronto
Kingston General Hospital, Kingston
Royal Victoria Hospital, Montreal
10: The following centres use sodium nitroprusside to control hypertension upon
rewarming immediately post CABG:
B.C. Childrens Hospital, Vancouver (sometimes)
St. Boniface Hospital, Manitoba
Ottawa Civic Hospital, Ottawa
Sunnybrook Hospital, Toronto
Royal University Hospital, Saskatchewan (occasionally)
Other drugs used:
Royal University Hospital, Saskatchewan (labetalol is 1st choice)
Protocol established:
Sunnybrook Hospital, Toronto
Ottawa Civic Hospital, Ottawa (involving sodium nitroprusside)
11: The following centres use combination epidural administration in plastic
syringes:
1) bupivacaine and morphine
2) bupivacaine and fentanyl
3) bupivacaine and hydromorphone
Misericordia Hospital, Winnipeg (#1 for severe pain, #2 in bags, pharmacy
prepares these solutions)
St. Boniface Hospital, Manitoba (#2, pharmacy doesn't prepare)
Ottawa Civic Hospital, Ottawa (#2, #3, pharmacy prepares)
Royal University Hospital, Saskatchewan (#1, #2, pharmacy doesn't prepare)
Kitchener-Waterloo Health Centre, Kitchener (#2, pharmacy prepares)
Mount Sinai Hospital, Toronto (all 3, pharmacy prepares only in minibags)
Ottawa General Hospital, Ottawa (all 3, pharmacy prepares)
QEII Health Sciences Centre, Halifax (all 3, pharmacy doesn't prepare)
Calgary General Hospital, Calgary
The Hospital for Sick Children, Toronto (#2, pharmacy doesn't prepare)
Cite de la Sante de Laval, Laval (#1, #2)
Kingston General Hospital, Kingston (all 3, pharmacy prepares)
Health Sciences Centre, Winnipeg (#2, #3, and bupivacaine, fentanyl, and
epinephrine - pharmacy doesn't prepare)
Note: most centres indicated that they used or prepared minibags for
epidural administration
Suppliers for PVC syringes:
Calgary General Hospital, Calgary (Thermo, for non-latax)
Ottawa General Hospital, Ottawa (B&D)
Ottawa Civic Hospital, Ottawa (plastic syringes from B&D)
12: The following centres have stop order policies for:
1) antiinfectives
2) anticoagulants
3) narcotics and controlled drugs
4) neuroleptics
5) other
Royal Alexandra Hospital, Edmonton (#1, 7days except anti TB drugs, #3,7
days, #5, ergot alkaloids - 7 days)
St Joseph's Health Centre, Toronto (#1, #3)
The Moncton Hospital (have a "duration of therapy" policy - MDs indicate
duration of therapy and stop dates indicated, medications assigned a 2 day
stop date if duration not indicated, medications not assigned a stop date are
flagged for reassessment the next day)
Children's Hospital of Eastern Ontario, Ottawa (#1, #2, #3)
Misericordia Hospital, Winnipeg (#1, #2, #3, #5, ophthalmic
steroid/antibiotic combinations)
Hamilton HSC, Chedoke-McMaster Campus (all combinations)
Clarke Institute, Toronto (#1, #2, #3)
Royal Victoria Hospital, Montreal (all 5)
B.C. Childrens Hospital, Vancouver (#3)
St. Boniface Hospital, Manitoba (#1, #2 [some] #3, #5)
Ottawa Civic Hospital, Ottawa (#1, #2, #3, #5 - bedtime sedatives)
all categories to be reviewed to see if change required
Royal University Hospital, Saskatchewan (all 5)
Kingston General Hospital, Kingston (#1, #2, #3, #5)
Kitchener-Waterloo Health Centre, Kitchener (#1, #2, #3, #5 - benzodiazepines)
Calgary General Hospital, Calgary (#1, #2, #3, #4)
reviewing all categories but antiinfectives
Mount Sinai Hospital, Toronto (#1, #2, #3, #5)
reviewing #3, and current 30 day reorder policy
Ottawa General Hospital, Ottawa (ASO policy eliminated, retrieve prescribing
information from reports)
Sunnybrook Hospital, Toronto (#1, #3)
Toronto East General Hospital, Toronto (#1 - 4 days IV, 7 days po, #2 - 7 days,
#3 - 3 days IV, 7 days po, #4 and #5 - 31 days)
The Hospital for Sick Children, Toronto (#1, #3, #5)
Health Sciences Centre, Winnipeg (#1, #3)
Victoria General Hospital, Victoria (all 5)
13: The following centres have a chart for medications cleared by dialysis:
Ottawa Civic Hospital, Ottawa (completed in 1993)
Kingston General Hospital, Kingston (Amgen has a 1994/95 chart)
Health Sciences Centre, Winnipeg (Amgen chart)
References:
B.C. Childrens Hospital, Vancouver (Bennett's, and individual published
papers on CVVHD
Royal University Hospital, Saskatchewan (Bennett's)
Calgary General Hospital, Calgary (Bennett's)
Sunnybrook Hospital, Toronto (HD unit refers to "pocket card" from
Dialysis & Transplantation (JRL), Dec 1991, (Cuther RE, MD, Forland
SC, PharmD - includes po dosing)
Ottawa Civic Hospital, Ottawa (Bennett's 3rd ed)
Information to Share:
Drug Evaluations
Royal Alexandra Hospital, Edmonton: Growth hormone in catabolic states
Clarke Institute, Toronto: Use of zuclopenthixol acuphase
Royal Victoria Hospital, Montreal: Mycophenolate mofetil, ritonavir, indinavir,
stavudine, cycloserine, comparison of once daily ACEI
Ottawa Civic Hospital, Ottawa: Fluticasone propionate
Ottawa General Hospital, Ottawa: Somatostatin & analogues in the
treatment of acute variceal bleeding, and nursing notes: melatonin,
chromium, vandium, pressure ulcers
Toronto East General Hospital, Toronto: Azithromycin, Fleet phospho-soda
Victoria General Hospital, Victoria: Acarbose, lansoprozole
Patient Information Sheets
Clarke Institute, Toronto: psychostimulants, venlafaxine
Ottawa Civic Hospital, Ottawa: hepatitis B vaccine, warfarin
Royal University Hospital, Saskatchewan: ticlopidine - use in coronary
stent patients
The Hospital for Sick Children, Toronto: numerous parent med aids
Royal Victoria Hospital, Montreal: ventolin PO for premature contractions,
didanosine, zidovudine, saquinavir, zalcitabine - all in French and English
Investigational/Emergency drug data sheets
B.C. Childrens Hospital, Vancouver: epidural clonidine
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