CLINICAL CORNER

CDC Notification – Liquid Docusate

The Centers for Disease control (CDC) has communicated a warning regarding the use of liquid docusate in certain patients due to the risk of Burkholderia cepacia infections.  The identified infections have occurred primarily in ventilated patients without cystic fibrosis who are being treated in intensive care units. The CDC recommends that facilities not use any liquid docusate for patients who are critically ill, ventilated or immunosuppressed. Please contact Kimberly Griego, PharmD at KGriego@contractpharmacy.com or 267-487-9033 with any questions.
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Significant Shortages – Bicillin L-A & Tylenol ER 650mg

Bicillin L-A Shortage Update CPS currently does not have Bicillin L-A (penicillin G Benzathine) injection in stock.  All products are currently on backorder due to manufacturing delays.   CPS is in close contact with wholesalers regarding this shortage and it is anticipated the manufacturer will be shipping product soon. Bicillin L-A is penicillinase-sensitive penicillin indicated for mild to moderate upper respiratory Streptococcus infections and syphilis.  Bicillin L-A is the recommended treatment for syphilis and is the only option for pregnant women infected with[...]
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Bicillin L-A Shortage

There is a significant shortage of Bicillin L-A (penicillin G Benzathine) injection.  All products are currently on backorder due to manufacturing delays. Bicillin L-A is penicillinase-sensitive penicillin indicated for mild to moderate upper respiratory Streptococcus infections and syphilis.  Bicillin L-A is the recommended treatment for syphilis and is the only option for pregnant women infected with or exposed to syphilis. The Centers for Disease Control and Prevention (CDC) recommends that until the shortage of Bicillin L-A is resolved, clinicians should consider prioritizing[...]
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Affordable Care Act – Payroll Business Journal (PBJ) Reporting of Consultant Pharmacy Time

Beginning July 2016, skilled nursing facilities will be required to electronically submit staffing and census data to CMS.  To assist our clients with the submission of consultant pharmacist data, Contract Pharmacy Services will be adding an additional document to your monthly invoices.  This process will begin with your June 2016 invoice and will include the following data in a spreadsheet format with a separate line item for each date of consulting for both your skilled and your PC/AL consulting: Job title[...]
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DRUG SHORTAGE– IV Antibiotics and Add-vantage Normal Saline

Contract Pharmacy Services is advising customers that we continue to experience significant shortages of a number of IV antibiotic products.  At this time these products are unavailable or are in limited supply. To ensure timely availability of treatment to your residents select an alternative product when initially ordering IV antibiotics.  Below are some alternatives to consider. Normal Saline Add-vantage is in short supply. Due to this all Add-vantage IV medications can only be supplied in D5W. Pipercillin/Tazobactam (Zosyn) 375 gm and 4.5 gm[...]
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June Medications in the News

Drug’s Name Changes Due to Safety Concerns The US Food and Drug Administration (FDA) has approved a brand name change for the antidepressant Brintellix (vortioxetine, Takeda) to decrease the risk of prescribing and dispensing errors due to name confusion with the antiplatelet Brilinta (ticagrelor, AstraZeneca). The new brand name for vortioxetine will be Trintellix, and it is expected to be available starting in June 2016. Which Fluoroquinolone Antibiotic Carries the Greatest Risk of Tendinopathy? Tendinitis and tendon rupture are known serious adverse effects tied[...]
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Long-term Care Current Survey Focuses

Documentation of Non-Pharmacologic Interventions and Consultant Pharmacist Recommendations and Reports Contract Pharmacy Services feels it is important to assist our facilities in ensuring a positive survey outcome.   It has been brought to our attention that there are two areas that surveyors were currently focusing on.  Contract Pharmacy Services would like to share this information with all of our clients to assist you in achieving a positive survey outcome. Surveyors are focusing on documentation of psychoactive medications and the use of non-pharmacologic interventions. [...]
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Zika Virus and Insect Repellents

Zika virus can be contracted through the bite of an infected mosquito or through sexual contact. The biggest concern with Zika is in pregnant women due to the risk microcephaly in the infant. Since Zika virus is mosquito-borne there are many questions about which insect repellents to use. Here is a list of products that work and are safe in pregnancy. DEET (Off! Deep Woods, etc) 10%-30% DEET should be used. Select the concentration based on duration of exposure (10%[...]
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Quarterly Report: Bipolar Disorder

Bipolar disorder (BD), also referred to as manic-depression, presents with dramatic swings in a person’s mood and energy level, which affects their ability to perform daily tasks. Bipolar Disorder affects approximately 2.6% (some estimate as high as 6%) of the U.S. adult population with the average age of onset occurring at 25 years old. An estimated 82.9% of cases are classified as ‘severe.’ Approximately 48.8% of those with the disorder are receiving treatment, but of those, an estimated 38.8% are receiving minimally[...]
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CMS communication regarding Exit Conferences and edits to the State Operations Manual

For: Nursing Facilities The Centers for Medicare and Medicaid Services (CMS) released a communication to State Survey Directors regarding guidance on procedures for conducting exit conferences. This communication can be obtained here. Page 2 of the memorandum focuses on LTC Providers and current revisions to the State Operations Manual are found on pages 5-25. The following was discussed: CMS received questions regarding what degree of specificity surveyors should give when conducting an exit conference with providers, specifically regarding deficiencies found during federal survey. CMS has[...]
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