These bullets are provided by the Performance Improvement and Quality Assurance (PIQA) Committee for Valley Medical Center (VMC) healthcare providers in-order to improve patient safety (also available in the Pharmacy Website link). Here is the PDF of the July 2021 Medication Bullet.

Valacyclovir Renal Dosing Guideline

Valacyclovir, an antiviral usually prescribed for Herpes simplex virus, Herpes zoster, and other off-label indications, can be associated with toxic metabolic encephalopathy if not dosed appropriately based on the patient’s renal function. The renal dosing guideline based on CrCl (Creatinine Clearance) is noted below:
• CrCl 30-50: maximum dose 1,000mg q12h
• CrCl 10-30: maximum dose 1,000mg daily
• CrCl < 10 or on dialysis: maximum dose 500mg daily
This renal dosing guideline, the last CrCl calculation in the past 90 days, and the last 2 SCr (Serum Creatinine) in the past 90 days are all visible in the ordering page for valacyclovir (see screen shot below). Outpatient CrCl and Scr view will go-live on Monday 8/2/21. Please make sure to view this ordering page and to expand the order instruction whenever valacyclovir is prescribed. Other warning settings are currently being explored.

Adult Restricted IV Medication Pushes – Patient Placement Policy Update

The Adult Restricted IV Medication Pushes – Patient Placement Policy contains the guideline on patient placement and monitoring requirement of various IV medication pushes given in the inpatient setting. Two main practice changes as approved by PPC and P&T Committees are listed below:

• For Adenosine IV push administration, CAR/STAT RN or assigned ACLS certified RN presence will be required (in-addition to the current requirement of provider presence and cardiac telemetry monitoring).

• Haloperidol Lactate IV currently requires telemetry monitoring during administration. To alleviate the criteria during code grey and based on current clinical guideline, obtaining baseline ECG prior to IV administration is added as an option to fulfill the cardiac monitoring requirement. No change for IM route administration (cardiac telemetry monitoring is still not required).

On Monday 8/2/21, EPIC administration instruction for these 2 medications were updated and the updated policy will be uploaded online so these practice changes can be implemented.