Intravenous Administration of Formulary Medications - Pediatric/Neonatal - Inpatient/Ambulatory Clinical Practice Guideline
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Effective 7/8/2021. Contact [email protected] for previous versions Intravenous Administration of Formulary Medications - Pediatric/Neonatal - Inpatient/Ambulatory Clinical Practice Guideline Table of Contents Executive Summary ............................................................................................................................................... 3 Scope ...................................................................................................................................................................... 4 Methodology........................................................................................................................................................... 4 Definitions .............................................................................................................................................................. 5 Introduction ............................................................................................................................................................ 5 Recommendations ................................................................................................................................................. 6 UW Health Implementation ................................................................................................................................. 72 References............................................................................................................................................................ 72 Appendix A. Evidence Grading Scheme ........................................................................................................... 74 Appendix B. Medications Requiring Central Lines ......................................................................................... 75 Contact for Content and Changes: Philip Trapskin, Manager, Patient Care Services and Drug Policy Program Phone Number: (608) 263-1328 Email: [email protected] Guideline Authors: Joshua Vanderloo, PharmD Emily Zimmerman, PharmD Coordinating Team Members: Joshua Vanderloo, PharmD; Philip Trapskin, PharmD, BCPS Review Individuals/Bodies: AFCH Nursing Leadership: Barbara Byrne, VP AFCH Clinical Operations; Laura Ahola, Nurse Manager PUCU; Angela Baker, Nurse Manager NICU; Devon Christenson, Nurse Manager Diagnostic/Therapy Center; Carrie Cronk, Nurse Manager P4; Kirsten Koffarnus, CNS P5; Laura Konkol, CNS NICU; Kitty Montgomery, CNS P4; Anne Moseley, Director Pediatric Nursing; Sue Quamme, Nurse Manager PI44; Windy Smith, Nurse Manager P5 Deborah Soetenga, CNS PI44; Lori Williams, CNS PUCU Pharmacists; Brian LaRowe, PharmD; Nicole Lubcke, PharmD; Mary Mably, Pharmacy Coordinator Oncology, PharmD, BCOP; Aaron Steffenhagen, Pharmacy Manager Critical Care, PharmD, BCPS; Meghann Voegeli, Pharmacy Manager Pediatrics, PharmD Dan O’Connell, MD, Pediatric Gastroenterology Daniel Sklansky, MD, Hospitalist Benjamin Walker, MD, Pediatric Anesthesiology Copyright © 2021 University of Wisconsin Hospitals and Clinics Authority. All Rights Reserved. Printed with Permission Contact: [email protected] Last Revised: 06/2021 Effective 7/8/2021. Contact [email protected] for previous versions Committee Approvals/Dates: Pharmacy and Therapeutics Committee (Last Periodic Review: September 2014) • Interim Revisions: November 2014, January 2015, September 2015, Novemeber 2015, November 2017, December 2017, January 2018 Release Date: October 2016 Next Review Date: October 2018 Executive Summary Guideline Overview This guideline directs the appropriate administration of intravenous medications to pediatric patients across UWHealth throughout inpatient, procedural, and ambulatory settings. Necessary elements include appropriate level of care, monitoring, and physicochemical considerations. There are many medications given intravenously both in inpatient settings, procedural areas, or ambulatory care settings. The purpose of this guideline is to provide guidance for the administration of intravenous medications to pediatric patients across these care settings. The medications in this guideline were chosen based on their inclusion in the UWHC medication formulary and the units were administration is appropriate. These administration guidelines are not absolute; administration of intravenous medications should be tailored to fit the therapeutic needs of a pediatric patient as appropriate. Key Revisions January 2018 Minor Revision • Addition of siltuximab December 2017 Minor Revision • Midazolam use in general care areas for prolonged epilepsy monitoring November 2017 Minor Revision • Addition of guidance for rapid infusion of infliximab 2016 Periodic Review • Addition of new intravenous medications since previous September 2014 revision: ethacrynic acid, tocilizumab, isavuconazole, eculizumab, C1 esterase inhibitor (CINRYZE®), peramivir, levofloxacin, dinutuximab, doripenem, laronidase, granisetron, sugammadex, vedolizumab, lacosamide, defibrotide, daratumumab, vincristine • Clarification of magnesium administration rates for repletion, torsades de pointes, and bronchospasm • Addition of appendix detailing medications requiring central line Key Practice Recommendations The guideline includes recommendations for UWHealth formulary intravenous medications with respect to recommended infusion rates, considereations for administration, and monitoring of medications with administration. See table in Recommendations section for information on specific medications. Companion Documents • Guideline for the Management of Extravasation of Chemotherapeutic Agents – Adult/Pediatric – Inpatient/Ambulatory Clinical Practice Guideline • Guideline for Non-chemotherapeutic Agents: Prevention and Treatment of Chemical Phlebitis and Extravasation of Peripherally Administered Non-chemotherapeutic Agents – Adult and Pediatric – Inpatient Clinical Practice Guideline • Acetylcysteine (N-Acetylcysteine) – Pediatric/Adult – Inpatient Clinical Practice Guideline • Procoagulant Therapy for Treatment of Non-Hemophiliac Bleeding – Adult Clinical Practice Guideline • Granulocyte Colony Stimulating Factor – Adult/Pediatric – Inpatient Clinical Practice Guideline • Fosphenytoin and Phenytoin – Adult and Pediatric – Inpatient Clinical Practice Guideline • Therapeutic Dosing of Unfractionated Heparin – Pediatric/Neonatal – Inpatient Clinical Practice Guideline • Intravenous Immunoglobulin (IVIG) – Adult/Pediatric – Inpatient /Ambulatory Clinical Practice Guideline • High-dose Methotrexate, Leucovorin, and Glucarpidase Dosing, Administration, and Monitoring – Copyright © 2021 University of Wisconsin Hospitals and Clinics Authority. All Rights Reserved. Printed with Permission Contact: [email protected] Last Revised: 06/2021 Effective 7/8/2021. Contact [email protected] for previous versions Adult/Pediatric Intpatient Clinical Practice Guideline • Use of Rasburicase – Adult and Pediatric – Inpatient Clinical Practice Guideline • Intravenous Hypertonic Sodium Chloride – Adult and Pediatric – Inpatient Clinical Practice Guideline Pertinent UWHC Policies and Procedures • Policy 8.31 Guidelines for Hospital Location Specific Administration of IV Medications • Policy 8.33 High Alert Medication Administration • Policy 8.56 Pediatric Sedation • Policy 6.1.11 Preventing Non-therapeutic Exposure to Hazardous Drugs • Factor 7a Recombinant Operating Procedure • Factor 9 Complex Concentrate (PCC) Operating Procedure • Policy 10.18 Parenteral Lidocaine for Neuropathic Pain Scope Disease/Condition: Intravenous medication administration Extravasation of medications is not addressed in this guideline. For this information, refer to: • UWHC Guidelines for the Management of Extravasation of Chemotherapeutic Agents – Adult/Pediatric – Inpatient/Ambulatory Clinical Practice Guideline • Guideline for Non-chemotherapeutic Agents: Prevention and Treatment of Chemical Phlebitis and Extravasation of Peripherally Administered Non-chemotherapeutic Agents – Adult and Pediatric – Inpatient Clinical Practice Guideline Clinical Specialty: This guideline is intended for all personnel authorized to prescribe, to monitor, or to administer intravenous medications in all clinical specialties of pediatric practice. Intended Users: Physicians, advanced practice providers, pharmacists, and nurses Objective: To provide guidelines and monitoring parameters for the intravenous administration of UWHC formulary medications to pediatric patient. Target Population: Pediatric patients requiring intravenous medications. Interventions and Practices Considered: • Physiochemical properties of intravenous medications • Appropriate administration technique • Safe and effective dosing and administration rates • Key monitoring parameters for intravenous medications Major Outcomes Considered: • Safe and standardized administration of intravenous medications to prevent patient harm. Methodology Methods Used to Collect/Select the Evidence Electronic database searches, literature review,manufacturer labeling and tertiary care references were used to collect evidence for review. Methods Used to Formulate the Recommendations Available evidence from the literature, manufacturer labeling and tertiary references was combined to formulate recommendations. Clinical expert consensus was utilized to formulate specific recommendations and levels of care for administration. Copyright © 2021 University of Wisconsin Hospitals and Clinics Authority. All Rights Reserved. Printed with Permission Contact: [email protected] Last Revised: 06/2021 Effective