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

2. INTRODUCTION – BE CAREFUL IHS THE RISE OF RIVA

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

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

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

6. 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

7. 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

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

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

10. FDA.gov WEBSITE current shortages:

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

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

13. CONSIDERATIONS - Vials Programming Racks & Clips UV light aperture

14. PROCESS Get new medication Program new medication New Template STAT

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

16. Is Melville Spiderman?

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

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

19. EXAMPLES Plastic heparin vial vs. riva?

21. EXAMPLES Propofol

22. EXAMPLES Piperacillin / Tazobactam

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

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

25. QUESTIONS?