These days, it is common to have multiple physicians looking after a single patient. Each doctor writes his/her orders which may duplicate another doctor's orders. When you see an alert pop up on your screen as you enter orders which tells you that this is a duplicate order, please take a millisecond to determine if you really want that duplicate order or if the other doctor's order covers what you want. For example, if the ER doctor already ordered an EKG and your admission order set also wants an EKG, you will be asked if you want to discontinue one of the EKG's. Take a moment to decide if you really want your patient subjected to duplicate testing. Nursing has been asked to help us out with this. The nurses have been instructed to call doctors when they see duplicate orders and ask the doctor if he/she truly wants that redundant order. Please work with nursing collegially and simply let them know if you want that duplicate order or not.

Another helpful tip: If you filter your Orders to reflect "All Active Orders", then you can take a minute or two to quickly see which orders are still relevant to your patient's care. For those orders that are no longer needed, simply right-click the order and choose "cancel/dc" order. This will really help keep things easy-breezy on order management. Please call Lesley Bradley at ext. 4145 to arrange a quick one-on-one tutorial on this.

Remember: Only doctors (and Nurse Practitioners/Physician Assistants within the scope of their practice under physician supervision) can "write" orders. We are responsible for the orders entered on our patients. Let's be proactive in order management. After all, who would want to be a patient and get poked 17 times in a day for a CBC?

The FDA cites increased risk of cardiovascular events when used to treat chronic kidney disease.

On June 24, the U.S. Food and Drug Administration today recommended more conservative dosing guidelines for Erythropoiesis-Stimulating Agents (ESAs) when used to treat anemia in patients with chronic kidney disease (CKD) because of the increased risks of cardiovascular events such as stroke, thrombosis, and death. In addition, ESAs have NOT been shown to improve quality of life, fatigue, or patient well-being.

Drugs in the ESA class are epoetin alfa, marketed as Epogen and Procrit.

As a result, the package insert for ESA products now recommends:

For patients with the anemia of chronic kidney disease on dialysis, initiate ESA treatment when the hemoglobin level is less than 10 g/dL. If the hemoglobin level approaches or exceeds 11 g/dL, reduce or interrupt the dose of ESA.

For patients with the anemia of chronic kidney disease NOT on dialysis, consider starting ESA treatment only when the hemoglobin level is less than 10 g/dL and when certain other considerations apply. If the hemoglobin level exceeds 10 g/dL, reduce or interrupt the dose of ESA.

Sharp Grossmont Hospital's P&T committee has given Pharmacy the ability to HOLD ESA in the following scenarios:

CONTINUING THERAPY:
-Hgb > 11 in CKD patient on dialysis
-Hgb > 10 in CKD patient NOT on dialysis

NEW STARTS:
-Hgb > 10

Dancing with the Doctors
Friday, July 15
5:30 pm Hors d'oeuvres and 6 pm Dancing Lesson
Professional Instructors
$10 per person
SPOUSES WELCOME

Upcoming events: (details to follow)

• Monday, September 12 - General Medical Staff Meeting with Dr. Neil Farber, author of "The Blame Game"
• Wednesday, September 14 - SGH Medical Staff Happiness Committee "Afternoon of Tennis"

Are you interested in seeing a recently published issue of the E-Bulletin?