Consultant Pharmacist Report
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- Ophelia Stevenson
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1 A WOODWARD, BOBBIE Room #: A001A INSOMNIA PETIT, ANDIE Room #: A002B Lab Reminder Since the coumadin dose was increased on 6-29 and the antibiotic (Duricef) has been given, please check an INR. (Last done ) CHILDERS, F Room #: A013A Automatic Stop Order (ASOP)- PRN Hypnotic Hypnotic Intervention 1. GABAPENITN 200MG QHS PRN INSOMNIA 2. LOPERAMIDE 4MG AFTER EACH LOOSE STOOL PRN Please discontinue per the Facility Automatic Stop Order Policy. The policy states that any PRN medication not administered within a 60 day period should be discontinued. A direct Physician Order is not required. Please include in the order that the medication was discontiuned per ASOP. This will prevent drugs that are not used or turned over frequently from expiring in the cart and becoming an issue during survey. Thanks Saturday, May 10, 2014 Page 1 of 7
2 WIGGINS, C Room #: A014A Automatic Stop Order (ASOP)- PRN Anxiolytic Not Used in 60 days RE: LORAZEPAM 0.25MG QD PRN Anxiolytic Intervention Please consider discontinuation per the Facility Automatic Stop Order Policy. The policy states that any PRN medication not administered within a 60 day period should be discontinued. A direct Physician Order is not required. Please include in the order that the medication was discontiuned per ASOP. This will prevent drugs that are not used or turned over frequently from expiring in the cart and becoming an issue during survey. Thanks Saturday, May 10, 2014 Page 2 of 7
3 B AARON, R Room #: B007B ANEMIA (Last Hgb low and she receives iron) SPECHT, D Room #: B009B Follow-up Lab Request Drug Monitoring On the Levothyroxine was increased to 75 mcg. Usually, a follow-up lab is drawn within 4-6 weeks of a dose change to evaluate the change given the type of blood levels with levothyroxine. Please check with Dr. Abraham or Angela to see if a follow-up lab can be checked. SPECHT, D Room #: B009B DEPRESSION HYPOTHYROIDISM Saturday, May 10, 2014 Page 3 of 7
4 ALLISON, D Room #: B010B ALLERGIC KERATITIS H/O CONJUNCTIVITIS CHRONIC INSOMNIA C LINDER, F Room #: C005B Lab Reminder RE: LAB REMINDER The monthly K+ level was discontinued. (Also the KCl supplement) Please check to see if a follow-up potassium level can be checked following the d/c of KCl. The last level was high and 5.9 and a follow-up level will make sure the level is returning to normal versus a hemolyzed specimen. RENTERIA, M Room #: C012A DIABETIC NEUROPATHY Saturday, May 10, 2014 Page 4 of 7
5 D MIRAS, BERTHA Room #: D003B Anxiety Cellulitis Chronic Pain Depression GERD Insomnia metastatic breast and ovarian cancer H/O PE Urinary incontinence MIRAS, BERTHA Room #: D003B Monthly PT/INR Needed with Coumadin/ Anticoagulant Therapy Drug Monitoring Ms. Miras is currently on Coumadin 5mg qd. She has received antibiotic therapy (Doxycycline, etc.). Please make sure a PT/INR is checked weekly. The last INR is from 7/7/09. Please check an INR as soon as possible. KENDAL, C Room #: D012A Steroid Spray- rinse oral cavity following administration RE: FLUTICASONE NASAL SPRAY Please make sure that following each administration of this med that the patient rinses their oral cavity. This agent can decrease cell-mediated immunity leading to an overgrowth of candida. (yeast infection) Please add this parameter to the order. Thanks. Saturday, May 10, 2014 Page 5 of 7
6 KENDAL, C Room #: D012A ADVAIR dosed less than q12 hours Inappropriate Medication Administration RE: ADVAIR 2 PUFFS BID Because of the long-acting component (Salmeterol) this medication needs to be scheduled q12 hours vs 10a and 5p to avoid potential side effects. (tachycardia, anxiety, etc.) With this in mind, please change the administration times to allow 12 hours between administrations. SMITH, T Room #: D014B Automatic Stop Order (ASOP)- PRN Anxiolytic Not Used in 60 days RE: LORAZEPAM INJ 2MG/ ML PRN Anxiolytic Intervention Please consider discontinuation per the Facility Automatic Stop Order Policy. The policy states that any PRN medication not administered within a 60 day period should be discontinued. A direct Physician Order is not required. Please include in the order that the medication was discontiuned per ASOP. This will prevent drugs that are not used or turned over frequently from expiring in the cart and becomming an issue during survey. Thanks Saturday, May 10, 2014 Page 6 of 7
7 EDWARDS, ROBERT Room #: D015A PVD Type 2 diabetes Hypertension Hyperlipidemia BPH Hypothyroidism Falls Dementia Saturday, May 10, 2014 Page 7 of 7
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