ED Muskoka Physicians - Living the Dream

Updates from Antibiotic committee meeting

Hi team

A few updates from the Antimicrobial stewardship committee meeting today. Exciting I know.
1. FYI – Peritoneal Dialysis patients presenting with ?SBP – there are NO nurses at MAHC authorized to access these PD catheters to obtain a sample (as per discussion with OSMH & RVH dialysis staff). Appropriate management includes a stat phone call to Nephrology to arrange for transfer for workup and management. Empiric antibiotic choices should be discussed with Nephro prior to transfer.
2. Several new ordersets have been drafted and are going to P&T, look out for these to be posted soon to Entrypoint. Hopefully they are helpful and less burdensome than that awful general sepsis orderset we used to have:
  1. 1) Endocarditis Order Set

    2) Meningitis Order Set
    3) Diabetic Foot Order Set
    4) Spontaneous Bacterial Peritonitis Order Set

    5) Acute Diverticulitis

    6) Necrotizing Soft Tissue Infection

    7) Febrile Neutropenia
    8) CDI Order Set and PR Administration of Vanco

There is also a document entitled:  “Intraabdominal Infections” that is NOT an orderset but provides useful evidence-based info on appropriate antibiotics to select. It will be posted to ENTRYPOINT to use as reference if you wish to access it when writing orders (or send your med students to find it to do some ‘self-study’ time!)
If there are other infection-related order sets you would like to see (or if you think a review of the literature is required on any current ones) please let me know and I can bring to committee!
Lastly, nothing to do with antibiotics, but if you weren’t at pharmacy rounds the other week an interesting tidbit of info that came up: Did you know that our hospital spent over $12 000 on the Zofran ODT wafers last year? If we had subbed every ODT dose for a PO dose we would have spent just over $600.  I forget the exact numbers but the PO dose is somewhere around $0.11 and ODT is over $2.00, IV dose is under $1.00. Interestingly, the ODT is NOT buccally absorbed, it just dissolves and then has to be swallowed and is absorbed in the GI tract just like the PO dose (still takes about 30min) – so my takeaway is that (except for in kids where swallowing a pill is an issue) if the patient can’t take PO, just give IV and skip the ODT!
Enough for today, enjoy your weekend everyone.
ps – yes, we are still waiting on baby to arrive!

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