Cerner Bulletin Providers Issued: October 2, 2014
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- Ashlynn Craig
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1 Alert Warfarin Ordered without INR CPOE, Nursing and Pharmacy 10/13/14 S B A R Prescribers currently do NOT get a warning if warfarin is actively ordered and there has not been an INR result in the past 72 hours STTC approved rule to warn prescribers for this scenario Rule will fire an alert to prescriber if any order is placed in Powerchart and the conditions described above are met The prescriber will be able to add order for INR within the rule alert Go live Oct 13. See snapshot
2 FOD Form Removal ORDER: Major or Life Threatening Bleeding Anticoagulant Reversal Standing Orders (Kcnetra, PCC, FEIBA, NovoSeven) and Nursing- 10/7/14 S/B A R The form ORDER: Major or Life Threatening Bleeding Anticoagulant Reversal Standing Orders (Kcnetra, PCC, FEIBA, NovoSeven) was inadvertently left in Forms On Demand When available PowerPlans should be utilized and the FOD form should be removed Remove Order from FOD, utilize appropriate PowerPlan FOD Form: PowerPlan:
3 RBC Transfusion Indications -REVISION Physicians, NPs/PAs/ Nursin, Blood Bank 10/7/14 S B A/R Physicians requested additional indications for RBC Transfusion indications These were approved thru the Blood Bank Pathologists and MEC Specific patient populations have been included in the transfusion indications
4 Provider Per Commercial Payer Authorization New Ordering Physician Communication Type PowerOrders Users/Reviewers - October 1, 2014 FOR USE BY UTILIZATION REVIEW STAFF ONLY NOTE: Nursing and will not select this Communication Type
5 Therapeutic Substitutions CPOE, Nursing and Pharmacy 10/7/14 S B A R Therapeutic substitutions (TSubs) for CPOE must be built using product level names in order to ensure accuracy. Some changes will need to be made to medication orders to accomplish this task. STTC and MECs have approved all TSubs. This build helps ensure 1:1 matches from non-formulary meds ordered to the approved formulary meds. Product level names will need to be used (see examples below) Powerplans and Quick Orders will NOT be impacted EDs will NOT be impacted since they are currently using product level names for home meds documentation and eprescribing Resave favorites, if applicable, with the appropriate product level names. See examples below. Roll out of new and improved TSub batches begins 10/7/14. Examples Brand name saved as Favorite: Zocor Resave as product level name: Zocor 20 mg oral tablet Brand name saved as Favorite: Vytorin 10/40 Resave as product level name: Vytorin 10 mg-40 mg, oral tablet Key Point NOTE: Nonformulary meds will be converted to product level names in Cerner starting Oct 7, Evaluate favorites and resave any with appropriate product level names. SEE NEXT 3 PAGES FOR LIST
6 Therapeutic Substitution List: p.1/3 ACE Inhibitors Antiarrhythmics Antihistamines, 2 nd generation Antihypertensive, combinations moexepril (Univasc), perindopril (Aceon), quinapril (Accupril), trandolapril (Mavik); plus combination products (Accuretic, Lotensin HCT, Lotrel, Tarka, Uniretic, Vaseretic, Zestoretic) propafenone extended release (Rythmol SR) cetirizine (Zyrtec), desloratadine (Clarinex),fexofenadine (Allegra), levocetirizine (Xyzal), plus antihistamine combinations that include pseudoephedrine spironolactone-hydrochlorothiazide (Aldactazide), BiDil, Dyazide Anti-infectives ARBs Beta agonists Beta agonist, long acting Calciums, oral CCBs amoxacilin-clavulanate extended-release (Augmentin XR) 1,000 mg, Ticarcillin-clavulanate (Timentin),Nystatin/triamcinolone cream or ointment, mupirocin (Bactroban) cream or nasal oint azilsartan (Edarbi), candesartan (Atacand), telmisartan (Micardis), eprosartan (Teveten), irbesartan (Avapro), olmesartan (Benicar); plus combination products (Atacand HCT, Avalide, Azor, Benicar HCT, Diovan HCT, Exforge, Hyzaar, Micardis HCT, Teveten HCT, Tribenzor) levalbuterol (Xopenex), albuterol (Proventil/Ventolin) salmeterol (Serevent Diskus) calcium carbonate, -lactate, -citrate, -gluconate, -oxide); calciumvitamin D carvediolol CR (Coreg CR), nisoldipine extended release (Sular); plus combinations (Tekamlo)
7 Therapeutic Substitution List: p.2/3 Corticosteroid inhalers Corticosteroid plus long-acting beta agonist inhaler Estradiol patches Fenofibrates H2 Receptor blockers Iron, oral Magnesiums, oral Miscellaneous Nasal steroid sprays Ophthalmics beclomethasone (QVAR), budesonide (Pulmicort), ciclesonide (Alvesco), flunisolide (Aerobid), mometasone (Asmanex) budesonide/formoterol (Symbicort HFA); fluticasone/salmeterol (Advair HFA); formoterol/mometasone (Dulera) Alora, Climara, Esclim, Estraderm, Fempatch, Vivelle-DOT Antara, Fenoglide, Fibricor, Lipofen, Lofibra, TriCor, Triglide, Trilipix cimetidine (Tagamet), ranitidine (Zantac); nizatidine (Axid) carbonyl iron (Feosol), ferrous fumarate (Hemocyte), ferrous gluconate, Feosol Spansule, Slow Iron, polysaccharide-iron complex (Niferex, Poly-iron) magnesium gluconate, -aspartate,-lactate, -oxide); sevelamer (Renagel); atenolol/chlorthalidone (Tenoretic), amiloride/hydrochlorothiazide (Moduretic), diclofenac/misoprostal (Arthrotec), dalteparin (Fragmin), donepezil (Aricept) 23mg,; dutasteride (Avodart), dutasteridetamsulosin (Jalyn),Fleet phosphate enema, megestrol ER (Megace ER) 625 mg susp,; olanzapine/fluoxetine (Symbyax), phenobarbital (15mg, 30mg, 60mg, 100mg), quetiapine extended release (Seroquel XR), omeprazole/sodium bicarbonate (Zegerid) beclomethasone nasal (Beconase AQ), budesonide nasal (Rhinocort AQ), ciclesonide nasal (Omnaris), flunisolide nasal (Nasalide), fluticasone nasal (Veramyst), mometasone nasal (Nasonex), triamcinolone nasal (Nasacort AQ) brimonidine 0.1%, 0.15%; bimatoprost 0.01%, 0.03%; Travoprost 0.004%; sulfacetamide 10%/prednisolone 0.2% SOP Ophth oint or Ophth susp
8 Therapeutic Substitution List: p.3/3 Opioids Proton pump inhibitors Sedatives/Hypnotics Statins/Statin Combinations morphine extended release (Avinza, Kadian), tapentadol (Nucynta, Nucynta ER) dexlansoprazole (Dexilant), esomeprazole (Nexium), lansoprazole (Prevacid), rabeprazole (Aciphex), omeprazole (Prilosec), pantoprazole (Protonix) 20mg; Prevpac estazolam (Prosom), eszopiclone (Lunesta), flurazepam (Dalmane), ramelteon (Rozerem), zaleplon (Sonata), zolpidem CR (Ambien CR); zolpidem any dose > 5mg for pts >65yo fluvastatin (Lescol), fluvastatin extended-release (Lescol XL), lovastatin (Mevacor), rosuvastatin (Crestor), simvastatin (Zocor); Advicor, Caduet, Juvisync, Simcor, Vytorin
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