ICU Prescribing Made Easy 2017

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ICU Prescribing Made Easy
2017
Quick Guide to Safe
Prescribing on
Commonly Seen Drugs
Hello!
This guide will show you what we:
MUST prescribe
MUST do to enable safe dosing
MUST Dos – there’s not many
 Allergy
status
 VTE assessment
–
–
On ICU admission
24 hours after ICU admission
 New
antimicrobials documented in
medical notes – indication and
expected duration
Antimicrobial Prescribing I



Apart from writing in the notes, the drug
needs an INDICATION and expected
REVIEW date – see ICU antimicrobial
table in your handbook for suggested
duration.
If not found in the handbook, put 5-day
review….and discuss with Micro
Micro rounds are daily on GICU and every
Mon and Thurs pm on CTICU & NICU
Antimicrobial Prescribing II

Aminoglycosides
–
Amikacin – 15mg/kg OD OR maximum 1250mg
if large patient with unknown adjusted weight

–
–

Urinary catheter change – 250mg STAT
Ask the pharmacist for dosing advice in obese
and/or renally impaired patients
Gentamicin still required for endocarditis
Second dose is ALWAYS at 12noon the
next day. Request level sample taken at
6am.
Antimicrobial Prescribing III



Vancomycin continuous
infusion
Please check the protocol
on the intranet
Protocol requires:
–
–

A loading dose over 2
hours then
A continuous infusion over
24 hours.
Request a sample level
usually at 6am the next
day or 4 hours post
initiation
Here’s the sticky points:
 Starting dose is according
to the patient’s renal
function
 Daily prescriptions MUST
be prescribed on the paper
and electronic charts.
 ePMA prescriptions:
–
if dose change – use
cancel/reorder function).
Alter the rate, not the
bag concentration
Pre-printed Drug Entries I (ePMA –
‘Adult Critical Care’ Power Plan)
Regular prescription
page:
–
Ranitidine

–
–
–
–
Enteral is preferred
Senna
Docusate or Movicol
Simple eye ointment
Dalteparin 5000 units
SC OD (GICU/paper
chart)
Intravenous infusions
–
–
Propofol 1%
Potassium

Enteral is preferred
–
Actrapid insulin
–
Addiphos
Magnesium
Sando K
Ondansetron
As required
–
–
–
Pre-printed Drug Entries II



These drug lines are there to help speed the
prescribing process
BE MINDFUL – not all entries apply to your
patient
Check VTE assessment order – these are
completed ONCE on Day 1 and Day 2 of ICU
admission
–
Note that:


a patient’s hospital admission generates an automatic VTE
task and alert
The Adult Critical Care power plan has a VTE Assessment
order available to tick as a required task.
Supplementary Charts on the ICU Continuous Renal Replacement


Nurse will require a prescription prior to starting
CRRT
Chart prompts calculation for:
–
–

Ideal body weight (the table is on the Aquarius
machines)
Dose
Consider
–
–
Fluid balance
Anticoagulation – must be prescribed on the drug chart.
Other Supplementary Charts on the
ICU


Patient controlled analgesia (PCA)
Epidural analgesia (levobupivacaine)
Where are all our drug
protocols?
Need to know IV dosing limits? Our
ICU Prep Guide can help!
Need to know more?
 Lots
of people you can ask. Please
do ASK
– Patient’s nurse
– Consultant, SpR & Nurse in
charge
– Pharmacist (ICU and on-call)
Electronic Prescribing



Ensure you have read the Prescriber
Pocket Guide
Be AWARE the screen shot can have a lot
of information which should be adjusted or
populated when ordering a drug
Review drug list daily and delete ICU
drugs no longer required
–
The drugs will still be ‘active’ when a patient
transfers to a ward
Learning to use the system

Try the online learning platform
–
http://icliptraining.premieritelearning.com/
–
Prescribing is in Section 2 for Doctors
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