Approved for Formulary

Discussion
The Committee was presented with a list of antiretroviral medications to be added to the Formulary. The Pharmacy and ID Unit approved maintaining a continuum of care for patients currently on highly active antiretroviral therapy (HAART) during their admission. The Committee approved the following list of antiretrovirals to the Formulary:

• Abacavir, Lamivudine, and Zidovudine combination (Trizivir® tablets)
  
• Atazanavir (Reyataz®) 100mg, 150mg capsules
  
• Fosamprenavir (Lexiva®) 700mg tablets
  
• Adefovir (Hepsera®) 10mg tablets
  
• Emtricitabine (Emtriva®) 200mg capsules
  
• Abacavir (Ziagen®) oral solution 20mg/ml

Discussion
The Committee was presented with the revised version of the NICU dosing card. The card was developed by the Mass General Hospital for Children as a guide to the pediatric residents and fellows. The following updates to the 2003 NICU Dosing Card have been made:

• Midazolam dosing and morphine dosing based on Harriet Lane 16th Edition
• Change penicillin to oxacillin due to increased utilization
• Delete ranitidine load; never used
• Delete metoclopramide (give 30 minutes prior to meals), as this is not routinely done. Tube feeds are administered every 3-4 hours
• Add <36 week gestational dosing for ranitidine
• Delete TPN labs, as they are now part of POE
• Delete erythromycin; no longer recommended
• Change caffeine from mg/kg/day divided by 24 hours to mg/kg/day

The Committee approved the above changes to the NICU dosing card 2003 with no suggested revisions. Copies of the card will be available as new pediatric house staff start.

Approved

Discussion
The Committee was presented with the propofol and pentobarbital administration guidelines for Sedation for Intractable Distress for the Dying Patient (SIDD Pat). Propofol and pentobarbital are used in these guidelines as sedating medications to relieve the intractable distress and symptoms that cannot be adequately controlled with traditional analgesics despite aggressive efforts in terminally ill patients. Both the propofol and pentobarbital guidelines have been approved by the Nursing Practice Committee. The Committee suggested that the order in POE be clearly written to describe appropriate dosing and monitoring parameters and that a template be developed. The Committee also recommended that the nursing staff administering the drugs receive ample education and support regarding the care of these patients. The Palliative Care or Pain Service attending physician must be involved with the care plan in these patients.

The Committee approved the pentobarbital policy with no suggested revisions.

The Committee approved the propofol policy with minor editing. Suggested initial dose of 10-20mg per hour and delete weight-based dosing and that the infusion must be changed after 12 hours of use in addition to the IV tubing, and to change notification of the pharmacy from 60 minutes to 2 hours for the next vial of propofol.

Approved

Discussion
The Committee was presented with the "Heparin to Maintain Patency of Central Lines"-Newborn Collaborative Policy. Due to an increased risk of intraventricular hemorrhage in low birth weight newborns, the heparin concentration was changed from 1 unit/ml to 0.5 unit/ml. The Committee approved the document with no suggested revisions.

"Hepatitis B Vaccine HBS-Ag-negative Mothers"- Newborn Collaborative Policies

Approved

Discussion
The Committee was presented with the "Hepatitis B Vaccine HBS-Ag-negative Mothers"-Newborn Collaborative Practice policy. In the past, neonates weighing less than 2 kg were discharged from the hospital without receiving Hepatitis B Vaccine (HBV). Current information from the American Academy of Pediatrics (AAP) recommends all preterm and term neonates weighing less than 2000 grams and who are medically stable should receive the first HBV prior to discharge. The Committee approved the policy with no suggested revisions.

Approved

Discussion
The Committee was presented with the Newborn Collaborative IV nutritional recommendations. The addendum includes: A low UVC (umbilical vein catheter) positioned pre-liver is a unique situation. This line is not considered peripheral or central. As a general rule, the preferred route of administration for medications will be a central line, then a low UVC, and lastly, a peripheral line. Please check with the unit pharmacist and/or attending regarding any questions for the administration of medications.
Total parenteral nutrition administered through a low UVC may contain up to 0.5mEq/Kg of calcium. This is at the discretion of the attending on-service.
This was an addendum to the previously-approved document in which a low UVC can be considered for administration of medications. The UVC is not preferred over a central line, but is preferred over a peripheral line. Any questions regarding administration of medications through this type of a line should be directed to the unit pharmacist and/or attending physician. The Committee approved the addendum with no suggested revisions.