Calculations
Fenil orders Vancomycin 20mg/kg for sepsis coverage on a 89kg patient. What is the calculated dose?
20 mg/1 kg * X mg/89 kg = 1,780mg
Double points if answer is 1750mg or 2g even
The hospitalist creates an order "Continue home medications". Per our policy, is this acceptable?
No
Each home medication the provider wants to continue needs its own individual order
(drug name, dose, route, and directions)
How many vials of CroFab are in OMNI?
6
Your order for vancomycin is 1500mg in 500mL bag. You reconstitute the 2 vials and pull out 30mL of drug. How long do you infuse the medication for? What is that rate?
1g/ 60 min * 1.5g / X min = 90 min
530mL /90 min * X mL / 60 min = 353mL/hr
What frequency is Lovenox administered for a patient with a clot?
BID
Derek tells you to make Zosyn 4.5g for sepsis coverage. 1 Vial of Zosyn 3.375g = 10mL after reconstitution. How many vials and what total volume do you need to make the ordered dose?
3.375 g/ 10mL * 4.5 g/ X mL = 13.3mL total ~2 vials
If an inpatient brings in medications we have on formulary, and the hospitalist agrees they should continue their course, should you suggest the provider write an order from our supply and retrieve from OMNI, or allow the patient to take from their bottles?
Per policy, any medication the patient takes that is on formulary (or can be easily substituted to an alternative we stock, must come from OMNI.
The provider orders the nursing CIWA protocol. You score the patient a 6. But notice their vitals are abnormal. What is the new score if the patient's BP is 162 mmHg and their heart rate is 120 bpm? Which benzo should you use if they have a large concern for withdrawal? (dose and frequency)
Score = 8 and Ativan 2mg q2h
Which route is haldol administered in our facility?
IM
A patient is ordered Ketorolac 60mg but the drawer only has 1 vial. What should you do?
Cycle count ketorolac to see if there is an additional drawer.
Sanjay has a tylenol overdose patient (95 kg). In OMNI there are 4 vials of Acetylcysteine (6g in 30mL). Calculate the dose for each of the 3 bags.
Bag 1= 150mg/kg
Bag 2= 50mg/kg
Bag 3= 100mg/kg
Do you have enough vials?
Bag 1= 150mg/kg * X mg/ 95 kg = 14.25g
Bag 2= 50mg/kg * X mg/ 95 kg = 4.75 g
Bag 3= 100mg/kg * X mg/ 95kg = 9.5g
Total dose = 28.5g
6g / 30mL * 28.5g / X mL = 142.5 mL ~ 5 vials
The patient told you they take spironolactone. You check EPD to see if its on formulary. It is not. The provider needs help imputing a home med order. How do you explain to them the process?
Orders > Free text order> enter required elements>schedule if needed> record.
Free text home med orders will show up on course and not in the MAR.
A 72kg COVID patient is not tolerating their BIPAP. Dr. Hamm tells you to grab the RSI kit. He says draw up etomidate and rocuronium. What are the doses? What does the dosing chart say is their durations?
Etomidate 0.3mg/1 kg * X mg/ 72kg = 21.6mg ~22mg lasts 3-5 minutes
Rocuronium 1mg/kg * X mg/ 72 kg = 72mg lasts 30-45 minutes
The 134 kg patient in room 7 came back from CT with a confirmed stroke. Jordan is working, and he orders Alteplase. You grab the tPA protocol and need to determine what to give. What is the Bolus dose, the remaining dose infusion rate, and time to start the NS flush?
Total dose = 90 mg (90mL)
Bolus dose = 9mL over 1 minute
Remaining dose rate = 81mL/hr
NS initiation = 47 min