Saturday, May 7, 2011

Pine Box Warning

I had to give a pine box warning to one of our pharmacists last night. The patient had a deep rapidly spreading infection and was allergic to penicillin and all cephalosporins. The infection appeared to be gas forming and we needed to jump on it in a hurry. He had already failed Flagyl. I wrote to get him started on 900 mg of cleocin every 8 hours asap and made arrangements to go to the OR. When the patient got to pre-op, he still had not received his cleocin. I called the pharmacy to see what was up and immediately was told that it had to be appoved by the pharmacy supervisor on call because cleocin had a black box warning. After I told them that I didnt give a ***it and that I wanted it now, I asked them what was the "lack box warning" It turns out that it can lead to C. difficile diarhea. I told them that I hope they do get diahrhea, that means that they will still be alive! Right now there is a Pine Box Warning, without it, they will be dead!

I got the cleocin and the patient did ok. Anerobic infections are no fun. Anyway the head of the pharmacy called me and apoligized for the delay. She told me that from the administratosphere and edict came out that to decrease complications that may lead to extended stays in the hospital (CMS) unfunded and possible litigation issues, they had instituted this Black Box Warning policy!


Chrysalis Angel said...

That poor patient. Such a nasty infection.

How very frustrating to deal with some of these things that are in place.

SeaSpray said...

Your patient was blessed to have you go to bat for him/her. Maybe you will have caused them to reexamine their policy. Doctors need to unite and push back when you see these things happening.

I say this as a patient who if God forbid were in that position, would hope my DR would do the same.

I learned something new. I had to look up "Anerobic infections ". Reminds me of working at the hospital. I'd get unnerved when I would discover some condition I never knew existed before. One more thing to think about. Then move on. :)

SeaSpray said...

Hi Throckmorton - don't know if you'll see this, but this is alarming. I can't believe things like this are happening. Do they have shortages like this and public just never hears about it?