Vancomycin Background (1:00) o P&T policy o Nomogram vs. traditional dosing Mechanism of action (2:30) Pharmacokinetics (5:42) Desired peak/trough (7:

Transcription

1 Warfarin Policy (1:03) Background (3:20) o Pharmacokinetics (4:48) o Monitoring (5:20) o Indications (6:30) Mission s dosing resources (7:18) Warfarin monitoring form (12:18) How to approach a consult (14:54) o New Start example (15:42) o Continuation example (38:40) Special considerations (46:45) o Bleeding o Medication history o Warfarin reversal o Trends o Warfarin batch o Tablet strength o Education

2 Vancomycin Background (1:00) o P&T policy o Nomogram vs. traditional dosing Mechanism of action (2:30) Pharmacokinetics (5:42) Desired peak/trough (7:30) Pharmacokinetic steps (8:42) Case (14:20) Vancomycin resources (20:45) How to fill out the monitoring form (24:30) How to approach a NEW START vancomycin (26:25) How to approach a CONTINUATION vancomycin (40:54) o When to check a level (42:30) o How to evaluate the level (42:50) Special considerations (47:30) Documentation (48:24) Recap (54:53)

3 Aminoglycosides Consult Process Steps (0:30) Scope of Practice (0:50) Basics (1:40) Step 1: Patient Information to Gather (4:00) Step 2: Evaluate for Exclusion Criteria (5:20) The Urban Craig Nomogram (6:08) Step 3: Initial Dosing Using Urban Craig (6:34) Nomogram dosing weights (7:29) Step 4: Obtain First Level with Urban Craig (8:40) Interpreting Levels (10:00) Ordering Subsequent Levels (10:40) Nomogram Caveats (12:12) o Above the nomogram or on the line (12:14) o Below the nomogram (13:24) Hartford Nomogram (14:36) Nomogram differences (15:50) Step 5: Monitoring Sheet (17:00) Where to find dosing resources and monitoring sheets (18:08) Pause for Practice Nomograms (19.38) Traditional Dosing (22:20) Pause for Practice Traditional dosing (25:35) Step 6: Monitoring for nephrotoxicity (30:27) Summary (32:11)

4 Phenytoin Policy & Pharmacist s Scope of Practice (0:14) Overview of Steps Involved in Phenytoin Dosing Consults (0:40) Background on Phenytoin (1:54) Non-linear/Michaelis-Menten Kinetics (3:29) Free Concentrations and Free Fraction (4:52) o Plasma Protein Binding (6:50) o Examples of Meds/Situations that can Alter Free Fraction(7:57) Step 1 Gathering Patient Info (8:26) Step 2 Check/Determine Initial Doses (10:08) o Loading Dose (10:13) o Infusion rate (11:38) o Maintenance Dose (12:21) o Dosing weights (13:25) Step 3 Obtain 1 st Concentration and Free Fraction Step 4 Utilize the Dosing Algorithm (16:43) o Caveats for Dosing (18:06) o Answers to Common Questions (19:59) o Utilizing Free Fraction (23:20) o Dosing with Tube Feedings (24:41) Pause for Practice #1 (25:52) Pause for Practice #2 (27:24) Step 5 Patient Monitoring Sheets (29:50) Where to Find Algorithm & Monitoring Sheets (30:16) Summary (31:40)

5 Targets and Renals The report o How to get the report (0:28) o What does the report look like? (1:35) o Filtering the report by unit (2:37) o Special things to note (5:27) Boxes Empty (5:50) o How to calculate creatinine clearance (8:05) Yellow (8:40) Green (9:55) Red (11:25) Enoxaparin dosing (11:40) TNF medications (13:00) Q12h and q24h dosing and rescheduling (14:15) Medications that are BOTH a target drug AND a renal drug (15:50) Real-time example of manipulating the report (18:02) Renal dosing policy (19:02) Why is renal dosing important? (19:45) Renal dosing protocol (20:40) GFR vs. CrCl (22:25) What weight to use for CrCl (25:00) How to find the full policy (27:20) Special Considerations (32:40) o Infectious disease physicians (32:41) o What it means if information is missing (34:10) o How to check for hemodialysis (35:05) How to approach the renal list (35:40) Example (37:58) Documentation (39:35) o Ad Hoc (40:40) IV to PO (46:46) o Policy (49:00) o Criteria for conversion (49:56) o Criteria in depth and where to find them (53:15) o Dosing equivalencies (1:05:00) o Uncharted tasks (1:06:00) o Formulations (1:08:25) o Specialists (1:09:45) o Template (1:11:08) o Documentation (1:11:52) Target Drug Monitoring (1:13:45) o What are target drugs? (1:14:30) o Target Drug List (1:17:00) o The template (1:18:00) o How to approach the target drug list (1:25:30) o What to do if the information you need isn t available (1:27:10) o Documentation (1:30:18)

6 How to Chart on Any Task Multi-patient task list (0:59) Task list in patient EMR (2:41) Ad Hoc charting (3:11) Parts of a task o Admin notes (4:06) o Med Dosing (6:16) o Education (8:54) o Med Hx Details (14:01) Summary (16:23)

7 How To TAKE a Medication History External Rx History (2:32) Insurance Coverage (4:55) Allergies (6:14) Patient Preferred Pharmacy (7:04) Taking the History: o Touchbase with bedside RN (7:43) o Approach & Enter (8:15) o Begin the Interview (9:27) o Confirm Info with 2 nd source (11:44) o Enter Med Hx into EMR (13:23) o Confirm Hx with Patient (13:33) o Chart a Note (14:03) Summary (14:11) How To DOCUMENT a Medication History Patient Preferred Pharmacy (1:44) Allergies (3:40) Adding Drugs (7:28) o Compliance (10:02) o Scroll vs. Rx bottle (14:37) o Misc Rx (17:10) o Sliding Scale (20:02) o Varied doses/day (20:52) New Med Entries o If patient not taking as prescribed. (22:57) o If patient states MD changed. (24:43) If OTC, self-prescribed. (25:41) o Antibiotics course. (26:39) o Monthly meds. (28:06) No Known Home Meds or Unable to Obtain Info (30:37) Leaving Med Hx Incomplete (31:03) Import via External Rx History (31:21) Summary (34:14)

8 How To Do a Mediation Teaching Touchbase with RN (0:11) Determine discharge plan (1:26) Print education materials (2:36) Head to floor! (3:26) Enter the Room! (4:17) Warfarin Education Example (5:02) Lovenox Education Example (12:56) Wrap-Up Education (18:18) Special Situations (18:37) Summary (19:56)

9 OneNote Accessing OneNote (0:28) Using OneNote Daily (2:38) Archiving (8:21) Weekend Tags (9:25) Summary (11:21) Access Accessing Access via Citrix (0:22) Search Access Tool (0:41) Using Access Form (1:26) Standout Situations (8:53)