7:15PM— [Phones Ringing Off the Hook]
Pharmacist: *Picks up the Phone”
Pharmacist: “Hello, Pharmacy!”
RN: “Can I give Cefepime and Vanco in the same line?
Pharmacist: *Professional Eye roll*
PAUSE. Let's backtrack. This is a call being made to the hospital pharmacy about IV Y-site compatibility before the nurse administers it to a patient. You, the Pharmacist, have several lines ringing and what seems like chaos unfolding as others call for missing meds at shift change. They have access to the same IV compatibility databases, yet they are calling to ask YOU for the answer.
Hold that eye roll back. You are the med expert in the building and have been called upon by a fellow healthcare professional to use your knowledge.
Why Should I Continue Reading?
Well, if you are any of the following:
- A community pharmacist: with several years experience, looking to switch into the hospital pharmacy sector
- A newly employed pharmacist: wondering why your caller cannot look this up themselves
- A pharmacist who is not yet comfortable answering this type of compatibility question
this article may be very useful to you.
The Answering Process:
You have been asked about Cefepime and Vancomycin IV compatibility. Luckily you are living in a world with technology and resources at your fingertips!
(Please be sure to always bring up the patient specific profile and see what drug formulation and concentration they are asking about. Who knows, you might have a nurse asking about a Vanco order that is supposed to be given orally!)
For this particular exercise, both drugs are as follows:
- Cefepime HCL 1g/50mL in D5W Premix IV
- Vancomycin HCL 750mg/150mL in D5W Premix IV
Hospital systems will have subscriptions to Lexicomp and/or Micromedex. (For this article I will be using Lexicomp, but steps are similar to Micromedex use as well!)
Let’s venture to Lexicomp now.
Ahhhh the mecca of tertiary drug info resources. From this homepage I will go into the “Trissel’s IV Compatibility” page. For those unfamiliar to this site, you may find the tab on the top blue banner.
Once there you will type in the medication names separately and click add. Once you click analyze, a compatibility chart will generate.
So now that you have generated a drug compatbility chart for Cefepime and Vancomycin, it is time to ANALYZE it.
This page can actually be the last step before telling the RN “yes” or “no”! If the Green C icon was featured on the chart next to the words Y-Site, then you would be able to give your caller the go ahead to run both meds at the same time. An answer of “no” would be appropriate if the RED I or NO DATA icons were featured next to Y-Site. Then you would be able to hang up and take care of the other calls coming through….
However, I chose not to let you off that easy. In this example, there is a Yellow “U” icon meaning this small journey must continue. Click on Y-Site to look at the details page shown below.
On this page there are several studies listed. No…you do not have to read them all. It looks busy, but becomes a piece of cake to maneuver around once you know what to look for!
Next, look at the drug columns to find Cefepime with the correct concentration in question. Cefepime 1g/50ml = Cefepime 20mg/mL
Your list of 7 studies just got cut down to 5.
Now you look at the vehicle column and search for Cefepime 20mg/ml that comes in D5W.
Your list of 5 has shrunk to 3!
You may narrow this list further by finding those who also have the correct Vancomycin concentration and vehicle. Vanco 750mg/150m = Vanco 5mg/ml. The vehicle is D5W.
And then there was 1…..
Only study #4 includes the specific drugs/concentrations/vehicles we are concerned about! And that particular row shows a finding of “Compatible”.
You can now see the light at the end of the tunnel!
7:15PM — [Phones Ringing Off the Hook]
Pharmacist: *Picks up the Phone”
Pharmacist: “Hello, Pharmacy!”
RN: “Can I give Cefepime and Vanco in the same line?
Pharmacist: “Give me a moment to verify that… Who is the patient?…You’re asking about the Cefepime 1g/50mL in D5W Premix IV and Vancomycin HCL 750mg/150mL in D5W Premix IV?…[Goes through steps above Like.A.Boss.]… Yes they are compatible.”
RN: “Awesome thank you”
7:17 P — [Call is ended]
No, Really. Why Did I Read This?
Let’s backtrack again to my intended audience.
To the community pharmacist: with several years experience, looking to switch into the hospital pharmacy sector. You can do it! Depending on how long its been since you graduated, you may experience some hesitation in actually switching to a hospital job. Job specific skills are best built while working and your confidence will increase as well. Most of the calls you will receive have a similar stepwise process to answering a compatibility question. If you were able and willing to understand the procedure above, than you can trust yourself to be able to learn the other skills that will be useful to know in the hospital pharmacy workflow. Hospital pharmacies also have many of the drugs you are already familiar with in the community setting. Don’t doubt yourself! YOU ARE THE MED EXPERT.
To the newly employed pharmacist: wondering why your caller cannot look this up themselves…They probably saw that YELLOW U for “uncertain” and chose to trust YOU and YOUR knowledge, rather than risk doing the wrong thing! Take pride in that trust you have been granted. The next time you wonder why they’re calling you for this, remember…YOU ARE THE MED EXPERT.
To the pharmacist who is not yet comfortable answering this type of compatibility question, here are some very appropriate phrases: “Use it or lose it”, “Practice makes perfect”, “When in doubt, search it out”. No one has all the answers to everything, but be willing to improve upon your insecurities every day. I have shown you the steps above, so hopefully this allows you to formulate some specific questions to ask your colleagues. Answer calls with your head held high. YOU ARE THE MED EXPERT.
