RIVA & DRUG SHORTAGES Dean Nielson, PharmD Central Pharmacist, PCMC Riva Users Meeting August 21 st, 2012

INTRODUCTION – BE CAREFUL IHS THE RISE OF RIVA

AGENDA Primary Childrens Medical Center Drug shortages and RIVA Considerations Process Lessons learned Examples Summary

Basic Wave Template Verdana 30pt. Primary Children’s Medical Center

An Intermountain Healthcare Facility Located in Salt Lake City, Utah Not For Profit Six State Service Area Lowest Cost Provider-Value Oriented

Primary Children’s Medical Center 291 beds Tertiary, teaching Trauma one center Cancer center Bone marrow transplant Solid organ transplant 90 bed behavior health unit 24 bed satellite unit in Riverton Remote same day surgery unit 340B Covered entity

PCMC Pharmacy Department 98 Employees Clinical Staff 7am to 11pm Emergency Room pharmacy services 20hr/day Investigational pharmacy service OR pharmacy team 50 Pharmacists Organized in clinical teams >150,000 doses/month 52% of doses injectable Automation

AGENDA Primary Childrens Medical Center Drug shortages and RIVA Considerations Process Lessons learned Examples Summary

DRUG SHORTAGES AND RIVA Unforeseen use of RIVA One of the best uses of RIVA

FDA.gov WEBSITE current shortages:

PCMC shortages Atropine Diazepam Diphenhydramine Fentanyl Furosemide Hydromorphone Midazolam Morphine Nalbuphine Naloxone Ondansetron Pentobarbital Propofol Etc.

CONSIDERATIONS – Intermediary Bags Set Concentration vs. Final Volume BUD & Stability TSB HPLC New concentration and added drug volume Poke limits

CONSIDERATIONS - Vials Programming Racks & Clips UV light aperture

PROCESS Get new medication Program new medication New Template STAT

NEW TEMPLATE IHS software support Melville Spiderman template info When? STAT

Is Melville Spiderman?

LESSONS LEARNED Use a double check Try to anticipate supply and potential issues

AGENDA Primary Childrens Medical Center Drug shortages and RIVA Considerations Process Lessons learned Examples Summary

EXAMPLES Plastic heparin vial vs. riva?

EXAMPLES Propofol

EXAMPLES Piperacillin / Tazobactam

SUMMARY Beneficial for PCMC Beneficial for other Intermountain facilities No Grey Market or compounding pharmacies Less wasted/unused drug

SUMMARY (cont.) Riva has been invaluable in dealing with shortages IHS has always provided quick, satisfying solutions to any issue

QUESTIONS?