Working with local information

Enter answers at utxr.org
Bob Badgett
Greg Bowling

Choosing antibiotics

UTI at UHS:

40 year old woman outpatient with 2 days of dysuria and no other symptoms. UA shows pyuria and positive nitrites.
Your attending wants to use ciprofloxacin . Based on our antibiograms, is this a good choice?
  
Finding antibiotic sensitivities at UHS
Click the link to 'UHS Clinical Resources'
Then scroll down and take the link, "UHS Antibiotic Susceptibilities"
Click image to enlarge.
  1. Alternatively, use clinical.uthscsa.edu
  2. Click 'Facility information'
  3. Click 'UHS'
  4. Click 'Antibiogram'

 

Cellulitis at VA

50 yo male ouitpatient with uncomplicated cellulitis without evidence of abscess. He has a sulfa allergy.
What antibiotic should be used?
  
Finding antibiotic sensitivities at the VA
  1. Use CPRS tools
  2. Click 'Service lines'
  3. Click 'Infection control'
  4. Click 'Antibiogram'
Click image to enlarge.
 
Alternatively: use clinical.uthscsa.edu
  1. Click 'Facility information'
  2. Click 'STVHCS'
  3. Click 'Antibiogram'
 

Working with formularies

Choosing drugs at UHS

Patient is 50 year old male. LDL=150, s/p MI.
The patient just got Carelink and is self-pay.
What statin should be used?

1. Carelink patients

Using Sunrise
  1. Change 'Manual entry' to 'Start of browse'
  2. Scroll down to Pharmacy
  3. Find the clinical category you need
Using Lexicomp
  1. Search for a drug
  2. Copy paste its 'Pharmacologic category' into a new search of Lexicomp (search the 'Pharmacologic category' field)
Using 'clinical.uthscsa.edu'
  1. Click 'Facility information'
  2. Click 'UHS'
  3. Click 'Carelink'
Using 'UHS Clinical Pathways / Guidelines'
  1. Scroll through this page to find what you need

2. Self-pay patients

Oops, he did not qualify for Carelink. What statin should be used?
  1. Use clinical.uthscsa.edu
  2. Go to 'Medical knowledge' -> 'Drug information' -> 'Prices & formularies'

3. Medicare patients

Now he has Medicare. What statin should be used?
  1. Use clinical.uthscsa.edu
  2. Go to 'Medical knowledge' -> 'Drug information' -> 'Medicare Plan D'

4. Medicaid patients

Now he has Medicaid. What statin should be used?
  1. Use clinical.uthscsa.edu
  2. Go to 'Medical knowledge' -> 'Drug information' -> 'TX Medicaid'

Choosing drugs at the VA

Now which statin should be used?
Your 50 yo male with LDL=150, s/p MI from UHS
... followed you to the VA.
  
Finding formulary information at the VA
If you are writing orders, then this is built into writing orders.
 
If you are not writing orders, then...
  1. Use CPRS tools or add 'clinical' to the address of the homepage on a va computer
  2. Click 'Service lines - Pharmacy and Formulary'
  3. Click 'South Texas Formulary'
Click image to enlarge.

Community information

Your patient was admited by Dr Greg Freeman for an MI.
(Missing information happens in 14% of private primary care encounters)
  1. Your patient forgot to bring their medicines that he gets from the HEB at I-10 and Wurzbach. What is the phone number of the pharmacy there?
  2. What is Greg Freeman's office phone?
  3. Is Greg Freeman certified?
  4. Your patient would like cardac rehab in San Antonio.