eStar changes and updates announced

Among the recent changes and updates to eStar:

Continuous IV Infusions

To optimize pharmacodynamics and maximize bacterial killing, continuous infusions of penicillin and nafcillin have been added as the recommended option for patients with normal renal function receiving penicillin G 24 million units IV and nafcillin 12 g IV in 24-hour period (see table below). Intermittent infusions will remain orderable.

This change is currently live and impacts all clinicians, nurses and pharmacy staff in Vanderbilt University Hospital.

The continuous infusion will automatically be pre-selected when dosing nafcillin, while the order set for penicillin will have two options: continuous vs. intermittent (based on creatinine clearance). These medications are now built into Alaris pumps under continuous file. Infusions will be administered via peripheral or central line.

• Clinicians: order continuous infusions
• Pharmacists: ensure appropriate renal function when penicillin continuous IV is ordered
• Nurses: ensure compatibility of continuous infusions with other intravenous products by confirming with pharmacy (in addition to selecting appropriate infusion duration within pump)

Please refer to the Tip Sheet “Continuous IV Infusion Education Penicillin and Nafcillin” (available within the Learning Home Dashboard and from Hubbl) for more information.

48-Hour Timeout for Antimicrobials

Beginning July 26, prescribers can now document review of antimicrobials at 48 hours from initiation and enter indications for their use. This change is being made to help reduce development of antimicrobial resistant pathogens. Additionally, as clinical/lab data is gathered and finalized, antibiotic therapy can be:

• Narrowed to targeted therapy;
• De-escalated if patient shows clinical improvement ; or
• Discontinued due to alternative diagnosis

The review of select antimicrobials is encouraged, but not required, at 48 hours following initiation of order. Clinicians will be able to select “review” in Orders section. Indications for use of antimicrobials may be selected upon order entry or modification of order

Please refer to the Tip Sheets “48 Hour Time-Out and Indications for Use” available within the Learning Home Dashboard and from Hubbl) for more information.

Add/Remove Team Following a Patient

A new order allows clinicians to add/remove teams following a patient. This is an ad hoc order, so will not appear in order sets and is limited to teams on specific services. These services will appear in dropdown list when selecting team to add/remove

Clinicians should search for and select order ADT44 to add and/or remove team following patient. They should also be careful to not remove primary team, which may appear in remove teams list.

Please refer to Tip Sheet “New Order: Add/Remove Following Team” available within the Learning Home Dashboard and from Hubbl) for more information.