The P&T Committee plays a critical role in ensuring safe, effective, and cost-efficient medication use in healthcare settings.
Key policies include:
1. Formulary Management by P&T Committee
Purpose: Maintain an approved list of medications for safe, effective, and cost-effective use.
Policies:
Review new drugs based on clinical evidence, safety, and cost.
Substitute costly brand drugs with generics if equivalent.
Periodic reviews to ensure ongoing relevance.
2. Inpatient Prescription Management
Purpose: Promote safe medication practices for inpatients.
Policies:
Use standard order sets for common drugs.
Set safe dose ranges for patient groups (e.g., pediatrics).
Implement alerts for drug interactions.
3. Outpatient Prescription Management
Purpose: Address medication needs post-discharge or in outpatient settings.
Policies:
Limit dispensed quantities to prevent overuse.
Set guidelines for refills.
Provide patient counseling on drug usage and safety.
4. Automatic Stop Orders
Purpose: Prevent unnecessary prolonged medication use.
Policies:
Apply duration limits on certain drugs (e.g., 5 days for antibiotics).
Require regular monitoring, with discontinuation if tests are missed.
Allow provider override if continuation is necessary.
5. Emergency Drug List Management
Purpose: Ensure essential drugs are available for emergencies.
Policies:
Compile a list of necessary emergency drugs.
Maintain adequate stock levels and monitor expiration.
Train staff on emergency drug use and administration.
These policies support effective and safe medication practices throughout the institution.
Here's a table summarizing commonly used emergency medications and their usual adult doses:
Drug | Usual Adult Dose | Indication |
Adenosine | 6 mg rapid IV push; may repeat with 12 mg | Supraventricular tachycardia (SVT) |
Amiodarone | 150-300 mg IV over 10 minutes | Ventricular fibrillation, VTach |
Atropine | 0.5 mg IV; may repeat up to 3 mg | Bradycardia |
Dopamine | 2-20 mcg/kg/min IV infusion | Shock, bradycardia |
Epinephrine (1:10,000) | 1 mg IV/IO every 3-5 mins | Cardiac arrest |
Epinephrine (1:1,000) | 0.3-0.5 mg IM or SC | Anaphylaxis |
Glucagon | 1 mg IM/IV/SC | Severe hypoglycemia when IV glucose isn't feasible |
Lidocaine | 1-1.5 mg/kg IV bolus | Ventricular arrhythmias |
Magnesium Sulfate | 1-2 g IV over 5-20 minutes | Torsades de pointes, eclampsia |
Naloxone (Narcan) | 0.4-2 mg IV/IM/IN; may repeat | Opioid overdose |
Sodium Bicarbonate | 1 mEq/kg IV bolus | Metabolic acidosis, tricyclic overdose |
Vasopressin | 40 units IV single dose | Cardiac arrest (alternative to epinephrine) |
This table provides general guidelines; specific doses may vary depending on clinical context and patient factors.