Decision

Comments

SMOF® Lipid:new indication for adult TPN patients approved.

SMOF® lipid is a form of lipid used in total parenteral nutrition (TPN). It is currently already on formulary for use in our NICU population. Data was reviewed for expanding this to our adult population. SMOF® contains omega-3-fatty acids, compared to Intralipid® which is 100% soybean oil based, containing omega-6-fatty acids. It is theorized the SMOF® may thus have anti-inflammatory properties. The committee agreed to add SMOF® to formulary in adult TPN patients with the following restrictions:

• Development of increased LFTs while on >14 days of Intralipid, OR
• Development of parenteral nutrition associated liver disease while on Intralipid®, OR
• Continuation of home therapy

Biosimilar additions (consent agenda):

Ogviri® (trastuzumab-dkst), Herzuma® (trastuzumab-pkrb), Trazimera® (trastuzumab-qyyp), Zirabev® (bevacizumab-bvzr), Ruxience® (rituximab-pvvr), Zarxio® (filgrastim-sndz), Nivestym® (filgrastim-aafi)

The biosimilars listed to the left were approved to add to formulary restricted to outpatient infusion center only with confirmed prior authorization.

Zostavax removed from formulary (consent agenda)

Zostavax has not been used or purchased at Valley for > 16 months given the superiority and increased supply of Shingrix®.

IVIG Inpatient Restrictions Lifted for ITP, Guillain Barre, and CIDP

IVIG is still on a nationwide shortage, however, due to slight improvements in the supply chain the following indications are no longer restricted for inpatient IVIG use:

1) ITP w/active bleeding or plts < 30k

2) Guillain Barre syndrome

3) CIDP

For each indication above, the maximum dose is 2g/kgtotal(can be given as 1g/kg x 2 days or 0.4mg/kg x 5 days). Consider lower dosing (1g/kg IV x 1 dose) to assess response, prior to ordering additional dose.
Additional IVIG indications/requests will be pending available supply and will be reviewed by Clinical Pharmacy Supervisor

Calcium orders in the hyperkalemia order set

To facilitate delivery of IV calcium for non-code situations, IV calcium orders on the hyperkalemia order set will be converted to IVPBs given over 5-10 minutes, as opposed to undiluted IV push over 5-10 minutes.

Quadrivalent adjuvanted flu-vaccine recommended for all patients ≥ 65y/o

New on the market for this year are two quadrivalent flu vaccines specifically indicated for the ≥ 65 year old patient population, Fluad Quadrivalent and Fluzone HD quadrivalent. Previously, these were only trivalent flu vaccines. The committee recommends defaulting to providing Fluad Quadrivalent vaccine to all VMC patients ≥ 65 years of age pending any further recommendations from ACIP, patient refusal, or inadequate supply.

Common canister policy approved

Respiratory therapy presented a policy regarding the use of common canister for MDI delivery for non-isolation patients. Policy was reviewed and approved by the committee to proceed to next steps of implementation.

Celecoxib-sulfa allergy removal from EPIC admin instructions

Currently, the EPIC inpatient admin instructions indicate “Do not give if sulfa allergy” for celecoxib orders. Literature does not support cross-reactivity between sulfa allergy patients and celecoxib. The decision was made to remove language regarding “sulfa” allergy from the admin instructions.

Pharmacy CDTA (collaborative drug therapy agreements) updates

Anticoagulation: Pharmacists will stop writing routine notes regarding heparin and argatroban infusion changes.

Pharmacokinetic: CDTA updated to reflect newer trough and AUC monitoring recommendations per IDSA and ASHP guidelines.