mssmem.com

I forget…what did that email say? oh yeah, its at mssmem.com

Archive for April, 2010

Correct Antibiotics for immunosuppressed patients going to ICU

(PNA core measure)

B-lactam (IV) + Macrolide (IV)

B-lactam (IV) + Antipneumococcal Quinolone (IV)

If documented B-lactam allergy: Antipneumoccal Quinlone(IV) + Aztreonam

B-lactam = Ceftriaxone, Cefotaxime, Ampicillin/ Sulbactam

Macrolide = Erythromycin, Clarithromycin, Azithromycin

Antipneumococcal Quinolones = Levofloxacin, Moxifloxaxin

B-lactam (IV + Macrolide (IV)
B-lactam (IV + Antipneumococcal Quinolone (IV)
If documented B-lactam allergy: Antipneumoccal Quinlone(IV) + Aztreonam
B-lactam = Ceftriaxone, Cefotaxime, Ampicillin/ Sulbactam
Macrolide = Erythromycin, Clarithromycin, Azithromycin
Antipneumococcal Quinolones = Levofloxacin, Moxifloxaxin

Written by reuben

April 28th, 2010 at 3:03 am

Revised MSH Therapeutic Hypothermia Protocol

Written by phil

April 23rd, 2010 at 5:27 pm

Posted in Hypothermia

BBFE Forms

I went to the needlestick meeting yesterday and just wanted to send along a few friendly reminders.
– When a blood or body fluid exposure presents to the ED we need to fill out the BBFE (blood and body fluid exposure) forms. The forms are found under “copies” in IBEX and each portion needs to be filled out completely. This helps the needlestick coordinators during follow up with the employee. After the forms are filled out, the most important part is getting the forms to the needlestick coordinator who picks them up in the morning. There is a folder that can be found behind the discharge desk in the main ED. When you discharge the employee you can ask the BA to scan the forms into the chart and then place in the folder. What I do to ensure that the forms get there is to make 3 copies. I give one copy to the employee, give one copy to the BA to scan into the chart, and I place the final copy into the folder. Admittedly a bit obsessive, but then I know that the forms are in the correct place. It was stated that there are often instances that the ED is not filling out the forms or not completing them correctly, so I hope that this review and my suggestions help. If anyone has any questions as to where to find the forms, how to fill them out or where to place them please contact me and I would be happy to go over things with you! :)
-Also, during the meeting I was surprised to hear that butterfly needles made up 50 out of 365 BBFE last year. We use butterfly needles a lot in the ED, either for repeat labs, ABG…etc. so I just wanted to review these as well. The most important thing to do after using the butterfly needle is to disengage the needle (close the needle) prior to placing it in the sharps container. Take your time and use 2 hands to push the safety over the needle to decrease the chance of an accidental stick. Also, you MUST disengage the needle prior to placing in the sharps container because if you do not another colleague is at risk of an accidental needlestick, and nobody wants that. Also, if you notice that the sharps container is 2/3 full you can call building services to have it changed. Please let me know if you need to review the use of the butterfly needle, or have any questions regarding this issue.
Thanks so much for your attention to this email, and let me know if you have any questions or concerns.
Carolyn

I went to the needlestick meeting yesterday and just wanted to send along a few friendly reminders.

– When a blood or body fluid exposure presents to the ED we need to fill out the BBFE (blood and body fluid exposure) forms. The forms are found under “copies” in IBEX and each portion needs to be filled out completely. This helps the needlestick coordinators during follow up with the employee. After the forms are filled out, the most important part is getting the forms to the needlestick coordinator who picks them up in the morning. There is a folder that can be found behind the discharge desk in the main ED. When you discharge the employee you can ask the BA to scan the forms into the chart and then place in the folder. What I do to ensure that the forms get there is to make 3 copies. I give one copy to the employee, give one copy to the BA to scan into the chart, and I place the final copy into the folder. Admittedly a bit obsessive, but then I know that the forms are in the correct place. It was stated that there are often instances that the ED is not filling out the forms or not completing them correctly, so I hope that this review and my suggestions help. If anyone has any questions as to where to find the forms, how to fill them out or where to place them please contact me and I would be happy to go over things with you! :)

-Also, during the meeting I was surprised to hear that butterfly needles made up 50 out of 365 BBFE last year. We use butterfly needles a lot in the ED, either for repeat labs, ABG…etc. so I just wanted to review these as well. The most important thing to do after using the butterfly needle is to disengage the needle (close the needle) prior to placing it in the sharps container. Take your time and use 2 hands to push the safety over the needle to decrease the chance of an accidental stick. Also, you MUST disengage the needle prior to placing in the sharps container because if you do not another colleague is at risk of an accidental needlestick, and nobody wants that. Also, if you notice that the sharps container is 2/3 full you can call building services to have it changed. Please let me know if you need to review the use of the butterfly needle, or have any questions regarding this issue.

Thanks so much for your attention to this email, and let me know if you have any questions or concerns.

Carolyn

Written by reuben

April 13th, 2010 at 8:19 pm

Posted in Needlestick

HIV PEP

I just typed this up for myself into an e-version off a hard copy “Pharmacy Bulletin” that we received- thought some of you might find it useful as well…
-L

Adults/adolescents:
Truvada (Tenovir/Emtricitabine): 1tab po qd c or s food
Atazanavir(Reyataz) 300mg po qd c food
Ritonavir(Norvir) 100mg po qd c food

Pediatric:
Zidovudine (10mg/ml prep or 300mg tab) 220 mg/m2 bid (max 300 bid)
Lamivudine (10mg/ml prep or 150mg tab) 4mg/kg bid (max 150 bid)
Lopinavir/ritonavir (80/20 mg/ml prep, 100/25 tabs, 200/50 tabs)
2w-6m: 16mg/kg lopinavir bid
>6m and <15kg: 12 mg/kg lopinavir bid
>6m and 15-40kg: 10 mg/kg lopinivir bid
>6m and >40kg: 400mg lopinavir bid

Written by phil

April 4th, 2010 at 1:40 am

Posted in ID,Needlestick