Issue 32
Number of responses: 27
1. The following hospitals have restricted formularies:
Queen Elizabeth II HSC
Mount Sinai Hospital
South-East Healthcare - The Moncton Hospital
Cite de la Sante de Laval
Sunnybrook HSC
Ottawa Civic Hospital
Hamilton Health Sciences Corp - MUMC site
Toronto East General Hospital
The Toronto Hospital
Misericordia Hospital
St. Boniface General Hospital
Royal Alexandra Hospital
Royal Victoria Hospital, Montreal
The Wellesley Central Hospital
St. Joseph's Health Ctr, Toronto
Saskatoon District Health DI Service
Health Sciences Centre, Winnipeg
Children's Hospital of Eastern Ontario
Royal Jubilee Hospital
Calgary General Hospital
Clarke Institute
Ottawa General Hospital
Documentation is required prior to use of a non-formulary drug.
Queen Elizabeth II HSC
Mount Sinai Hospital (pharmacist fills out request form if not product can be substituted - not all NF requests have a form completed)
South-East Healthcare - The Moncton Hospital
Cite de la Sante de Laval (form completed by pharmacist after discussion with doctor)
Toronto East General Hospital (pharmacist sends with drug)
The Toronto Hospital (drug not dispensed until form signed - for admission medications the pharmacist must complete the form if no suitable formulary alternative or if patient agrees to use own med)
St. Boniface General Hospital (poorly enforced)
Royal Alexandra Hospital (done by pharmacists at time of prescribing)
Royal Victoria Hospital, Montreal (a form is completed for each non-formulary drug, each time a new patient is started the indication must be stated)
St. Joseph's Health Ctr, Toronto
Health Sciences Centre, Winnipeg (no documentation required but i)
if specific criteria approved and not adhered to, the chair of P&T must
be contacted by prescriber for approval to use, or ii) if no specific
criteria, attempt is made to contact prescriber to use alternative -
exception is for short stay patients)
Children's Hospital of Eastern Ontario (no official mechanism of
enforcement)
Royal Jubilee Hospital (72 hours supply dispensed, then form must be
completed or no further drug - very difficult to enforce - pharmacist may
sign for if MD makes adequate documentation in chart or justifies its use)
Clarke Institute (do not dispense drug unless a non-formulary form
is completed
Ottawa General Hospital (only for new products on the market before
they are evaluated at P&T). Enforcement: form must be signed by head of
P&T
Percentage of forms completed:
South-East Healthcare - The Moncton Hospital (<50%)
Toronto East General Hospital (approximately 99%)
The Toronto Hospital (80%)
Misericordia Hospital (20%)
St. Boniface General Hospital (approximately 80%)
Royal Alexandra Hospital (58% completion rate for antibiotics)
St. Joseph's Health Ctr, Toronto, 75%
Children's Hospital of Eastern Ontario, 30%
Clarke Institute, approx 90%
Ottawa General Hospital, 100%
2. The following centres have guidelines for costing materials
to outside centres:
Cite de la Sante de Laval
Sunnybrook HSC (formulary $50, IV drug admin for RNs $75)
Ottawa Civic Hospital
Hamilton Health Sciences Corp - MUMC site (guidelines not established but are being developed)
Misericordia Hospital (Hospital policy; any manual will cost $100, individual policies and procedures can be shared with the exception of computerized care paths)
Children's Hospital of Eastern Ontario (manuals $25 - 40, for cost recovery)
Clarke Institute (charge $20 for full formulary, no cost for individual
pages
3. A protocol for urokinase use to clear line occlusions is
established at:
Queen Elizabeth II HSC (for central lines, assessment guidelines included)
Mount Sinai Hospital
South-East Healthcare - The Moncton Hospital (assessment guidelines included)
Cite de la Sante de Laval (hemodialysis patients only)
Sunnybrook HSC (assessment guidelines included)
Ottawa Civic Hospital
Hamilton Health Sciences Corp - MUMC site
London HSC - University Hospital
Misericordia Hospital (assessment guidelines included)
St. Boniface General Hospital
Royal Alexandra Hospital (assessment guidelines included)
Royal Victoria Hospital, Montreal (assessment guidelines included)
The Wellesley Central Hospital
Health Sciences Centre, Winnipeg
Children's Hospital of Eastern Ontario (assessment guidelines
included)
Calgary General Hospital (has a policy and procedure, assessment
guidelines included)
Ottawa General Hospital (for hemodialysis patients only, assessment
guidelines or criteria not included in protocol)
4. The following hospitals have care plans for specific infectious diseases:
Mount Sinai Hospital (for pneumonia - multidisciplinary care map)
Cite de la Sante de Laval (Quebec Pharmacie Sept-Oct 1997, Lysane Senechal - Infections de la peu et tissuemous, partie I et II)
Hamilton Health Sciences Corp - MUMC site (pediatric pneumonia)
5. Methacholine for inhalation (with predilutions) supplier:
Royal Victoria Hospital, Montreal (Laboratoires Omega Ltee)
Calgary General Hospital (Omega chemicals 1-604-271-6228, 50 mL
vials; 6.25, 12.5, 25, 50, 100, 200, 400, 800, 1600, 1920, and
3200 mg)
6. Drug Information requests via e-mail.
Efficient way to place/transmit enquiries?
Yes:
Queen Elizabeth II HSC
Mount Sinai Hospital
Hamilton Health Sciences Corp - MUMC site (for non-urgent requests)
London HSC - University Hospital
Royal Alexandra Hospital
The Wellesley Central Hospital
St. Joseph's Health Ctr, Toronto
Calgary General Hospital
No:
Medication Information Line for the Elderly (decided against allowing e-mail
requests due to high potential for lack of background information)
Ottawa General Hospital
Is sufficient information provided?
Yes:
London HSC - University Hospital
The Wellesley Central Hospital
St. Joseph's Health Ctr, Toronto
Calgary General Hospital
No:
Queen Elizabeth II HSC
Mount Sinai Hospital
Hamilton Health Sciences Corp - MUMC site
Royal Alexandra Hospital
Ottawa General Hospital
Is there an increase in the number of inappropriate responses?
Yes:
Calgary General Hospital
No:
Mount Sinai Hospital
Hamilton Health Sciences Corp - MUMC site
London HSC - University Hospital
Royal Alexandra Hospital
St. Joseph's Health Ctr, Toronto
Ottawa General Hospital
7. Pancrelipase is used to unclog J-tubes at:
Mount Sinai Hospital
London HSC - University Hospital (plus NaHCO3 and water)
The Toronto Hospital
St. Boniface General Hospital
Royal Victoria Hospital, Montreal
The Wellesley Central Hospital
Saskatoon District Health DI Service
Royal Jubilee Hospital
Calgary General Hospital (not used - unsuccessful)
Other methods:
Hamilton Health Sciences Corp - MUMC site (flush with warm water)
Toronto East General Hospital (warm water, coke, cranberry juice)
The Toronto Hospital (pancrelipase + NaHCO3 + 5 ml warm water, ref: Ann Pharmaco 1990;24:840)
Royal Victoria Hospital, Montreal (coke)
St. Joseph's Health Ctr, Toronto (flush with fluids)
Saskatoon District Health DI Service (Coke)
Health Sciences Centre, Winnipeg (sodium bicarbonate, Coke)
Calgary General Hospital (warm water for 5 minutes, club soda)
8. The following centres have a policy/guideline for
ondansetron post-op:
Mount Sinai Hospital
Ottawa Civic Hospital (only for PCA program)
Royal Alexandra Hospital
Health Sciences Centre, Winnipeg
Royal Jubilee Hospital (restricted to chemo induced N/V and wide
field radiation)
Calgary General Hospital (restricted to division of haem/onc and
anesthesia)
9. Bacitracin for surgical irrigation is used at:
Queen Elizabeth II HSC
Mount Sinai Hospital
South-East Healthcare - The Moncton Hospital
Sunnybrook HSC
Ottawa Civic Hospital
Hamilton Health Sciences Corp - MUMC site (occas in ortho)
Royal Victoria Hospital, Montreal
The Wellesley Central Hospital
St. Joseph's Health Ctr, Toronto
Saskatoon District Health DI Service
Health Sciences Centre, Winnipeg
Calgary General Hospital (in ortho department)
Ottawa General Hospital
Other options:
Hamilton Health Sciences Corp - MUMC site (normal saline as per ID)
Toronto East General Hospital (normal saline)
The Toronto Hospital (saline irrigation)
Misericordia Hospital (saline)
St. Boniface General Hospital (saline)
10. CIVA products in syringe form for syringe pumps are
prepared at the following centres:
Mount Sinai Hospital (NO - but have recently switched from syringes to minibags so have policies from past experience)
Ottawa Civic Hospital (for PCA program)
Hamilton Health Sciences Corp - MUMC site
London HSC - University Hospital
The Toronto Hospital (not routine, done on special request)
Royal Alexandra Hospital
Royal Alexandra Hospital
Calgary General Hospital (special care nursery only)
11. The following centres have a policy regarding docetaxel
vs paclitaxel use in treating breast cancer:
Queen Elizabeth II HSC (use docetaxel only)
Cite de la Sante de Laval
Toronto East General Hospital (follow OCTRF recommendations)
12. The following centres are reviewing the potential use of
nicardipene, if available, to treat hypertensive urgency pre/peri/post
operatively
St. Joseph's Health Ctr, Toronto
Saskatoon District Health DI Service
13. Sodium hypochlorite is used on wounds, grafts... at:
Queen Elizabeth II HSC (use on plastic surgery and burn unit - use is discouraged on long term care wards)
Mount Sinai Hospital (79x500 mL 1:20 strength, 73 x 500 mL 1:40 strength)
South-East Healthcare - The Moncton Hospital
Cite de la Sante de Laval
Ottawa Civic Hospital (approx 32 L/yr)
London HSC - University Hospital (Dakins 1/4 188L/yr, Dakins 1/2 95L/yr
Misericordia Hospital (used primarily on decubitus ulcers, use has declined over the years as MDs are encouraged to use saline and other agents - use is approximately 1 pt per month)
Royal Victoria Hospital, Montreal (on surgical floors)
St. Joseph's Health Ctr, Toronto (trying to reduce use on open wounds, decubitis
ulcers...)
Saskatoon District Health DI Service (plastics and orthopedics - 80 x 2 L
Dakins 1:24 in 1996)
Health Sciences Centre, Winnipeg
Calgary General Hospital (for necrotic wounds - use approximately
8 x 500 mL per year, full strength Hygeol)
Ottawa General Hospital (used for wound care, primarily in surgery
patients - use approximately 1L of Hygeol per month.
14. MDIs are recycled at:
Cite de la Sante de Laval
Ottawa Civic Hospital
Toronto East General Hospital (in ER, MDIs only re-used when used with aerochamber, the aerochamber is sterilized)
London HSC - University Hospital
St. Boniface General Hospital
Children's Hospital of Eastern Ontario
Calgary General Hospital (canisters only, higher doses required in
ICU and they will utilize any canisters not taken home by the
patients - jackets are not recycled)
Clarke Institute (keep MDIs but discard jackets, use MDIs as refills if a
patient requires more)
Ottawa General Hospital (only keep canisters and send it on the
floor when patients run out of their MDIs)
Method of sterilization:
Ottawa Civic Hospital (sent to Central Processing unit - washed in hot and soapy water and dried in a hot oven)
London HSC - University Hospital (either SterAdd (H202) or ethylene oxide)
St. Boniface General Hospital (gas sterilized(
Children's Hospital of Eastern Ontario (soak in savlon 1:100 for 2 hours,
then 70% alcohol for 2 hours)
15. The following centres have information on:
IRS-4:
Sunnybrook HSC
XE-41:
Sunnybrook HSC
Toronto East General Hospital
16. Compounding information for topical scopolamine:
Pharmacists Letter, Document #130714
International Journal of Pharmaceutical Compounding 1997;1(1):38.
17. The following DI centres have mission statements:
Royal Victoria Hospital, Montreal
Clarke Institute (part of department's mission statement)
18. The following centres have a recent IV compatibility chart:
Queen Elizabeth II HSC (June 1995, currently out of stock)
Cite de la Sante de Laval (own chart-price not established)
Toronto East General Hospital (In-house a y-site compatibility chart, also Y-site compatibility chart by Vancouver General Hospital, July 93, available free through an educational grant from Glaxo)
Royal Victoria Hospital, Montreal (developed in July 1997)
Royal Jubilee Hospital (obtained from St. Pauls Hospital, and modified
slightly, no cost)
Ottawa General Hospital. In development, price not established.
Information to Share:
Drug Evaluations
Queen Elizabeth II HSC: rational approach to insomnia therapy, role of nebulized solutions in obstructive lung disease
Ottawa Civic Hospital: carvedilol, desflurane
Toronto East General Hospital: lansoprazole
The Toronto Hospital: gemcitabine, carvedilol, topotecan
Royal Victoria Hospital, Montreal: budesonide, fluticasone, terbutaline, idarubicin, olanzapine
Patient Information Sheets
Dial Access/CDIC, Insect repellents - DEET
Investigational/Emergency drug data sheets
Publications
Pubmed - http://www.ncbi,nlm.nih.gov/PubMed)
AHA prevention of bacterial endocarditis - JAMA 1977;277:1794-1801 or Circulation 1997;96:358-66.
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last updated July 1997
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