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Related article: *26. Clients taking diuretics and cardiotonics e.g. digoxin, who have not had a serum potassium determination within 30 days after initiation of therapy and every 6 months thereafter. *27. Clients taking Butazolidin, Azolid or Tandearil continuously and have not had at least one CBC within 30 days after initiation therapy. *28. Use of cardiotonics e.g. digoxin in absence of documentation of one of the following diagnoses. congestive heart failure atrial fibrillation paroxysmal supraventricular tachycardia atrial flutter *29. Online Prescription Clonazepam Continuation of antiparkinson drugs in drug induced extrapyramidal symptoms (tremor, drooling, shuffling gait) without a challenge reduction of antiparkinson drugs. *30. The continuous Online Prescription Clonazepam use of antibiotic/steroidal ophthalmic preparations for periods exceeding 14 days. *31. The use of the following aminoglycosides (gentamicin, tobramycin, kanamycin, or netromycin) in absence of serum creatinine determination when therapy was initiated. a) Use of aminoglycosides in absence of serum creatinine clearance (estimate). 32. Orders for drugs for which there is a known allergy documented in client�s record. 33. The crushing of solid dosage forms when the likely result will cause client discomfort (e.g., Dulcolax) or undesired blood levels (e.g., Theodur). ADDITIONAL INDICATORS The following is a list of additional indicators that will be monitored during the pharmacy drug review process. These indicators were developed by a joint effort of the pharmacy and medical staffs and represent important additional parameters that pertain to client welfare. 34. As needed (prn) drug orders which have not been required for ninety (90) or more days. a) Vague medication orders. (Orders with missing drug strength, dosing frequency, treatment duration, or incomplete orders for Insulin.) 35. Continuous use of mineral oil for more than 30 days, or the use of MOM, Dulcolax, Senokot, and Online Prescription Clonazepam other laxatives every day or every other day, preventing, without clear documentation of need. 35. Use of potassium depleting diuretics without quarterly serum potassium levels (i.e. - use of diamox as an adjunctive anti-convulsant without monitoring for hypokalemia). 37. The empiric use of antibiotics for more than 14 days, unless clinically indicated. 38. Treatment of infections that have demonstrated resistance in vitro, to the prescribed antibiotic, without documented clinical improvement in the progress notes. 39. Clients who are placed on an antipsychotic, tricyclic antidepressant, or stimulant, without baseline EKG, unless special circumstances are prohibitive and documented. 40. Psychotropic medication changes without substantiating behavior(s) documentation, except for control of injurious behavior or in the treatment of specific medical conditions. 41. Psychotropic medication usage for inappropriate behaviors without approved behavior modification programs, except for emergency control of behavior or the treatment of specific medical conditions. 42. Non-compliance with medication titration plan (D4). 43. Psychotropic medication usage without properly executed informed consent in the record, except for the emergency control of behavior or the treatment of a specific medical condition. 44. Continuation of anti-parkinson drugs beyond twelve months in drug induced extrapyramidal symptoms, without a challenge reduction of the anti-parkinson drugs. 45. Medication schedules that inhibit absorption of medications including drug-drug and drug-food interactions.' 46. Use of anticonvulsants in subtherapeutic or supratherapeutic levels, without documentation. 47. Dosages in excess of manufacturer's recommendations, without documentation of specific need/efficacy. 48. Inappropriate drug administration parameters. (Orders for Fosamax without guidelines, VPA given on empty stomach, Citrucel given without adequate fluids ordered, drug ordered to be given incorrectly relative to frequency, i.e. Dilantin Infatabs daily.) 49. Pharmaco-economics drug utilization considerations. (Such as cost containment issues - use of Claritin rather than Drixoral, Prilosec before H2 antagonists efficacy noted, Zyprexa use prior to trial Abilify. Use of multiple 25mg Seroquel doses rather than daily combined dosage utilizing larger mg tablets.) 50. Geriatrics Indicators: Clients-65 years old G1. Propoxyphene should generally be avoided in the elderly. It offers few analgesic advantage over acetaminophen, yet has the side effects of other narcotic drugs. G2. Of all available nonsteroidal, anti-inflammatory drugs, Indomethacin produces the most central nervous system side
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