/clinical/,/clinical/cckm-tools/,/clinical/cckm-tools/content/,/clinical/cckm-tools/content/delegationpractice-protocols/,/clinical/cckm-tools/content/delegationpractice-protocols/inpatient-delegation-protocols/,

/clinical/cckm-tools/content/delegationpractice-protocols/inpatient-delegation-protocols/name-97306-en.cckm

201712356

page

100

UWHC,UWMF,

Tools,

Clinical Hub,UW Health Clinical Tool Search,UW Health Clinical Tool Search,Delegation/Practice Protocols,Inpatient Delegation Protocols

Medication Route Interchange - Adult/Pediatric - Inpatient [14]

Medication Route Interchange - Adult/Pediatric - Inpatient [14] - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Delegation/Practice Protocols, Inpatient Delegation Protocols


Delegation Protocol Number: 14

Protocol Title:
Medication Route Interchange – Adult/Pediatric – Inpatient

Delegation Protocol Applies To:
Patients admitted with inpatient, observation, or outpatient short stay status

Target Patient Population:
Adult patients meeting route interchange criteria as outlined in the UW Health Medication Route Interchange
Clinical Practice Guideline

Pediatric patients meeting route interchange criteria as outlined in the UW Health Medication Route
Interchange Clinical Practice Guideline

Delegation Protocol Champions:
Bartho Caponi, MD – Department of Medicine – Hospitalist
Daniel Sklansky, MD – Department of Pediatrics
Sheryl Henderson, MD – Department of Pediatrics Infectious Disease

Delegation Protocol Reviewers:
Philip Trapskin, PharmD – Drug Policy Program
Lucas Schulz, PharmD, BCPS AQ-ID – Pharmacy
Randy Braun, PharmD - Pharmacy

Responsible Department:
Department of Pharmacy

Purpose Statement:
To delegate authority from the ordering provider to a pharmacist to change the route of administration for
select medications between parenteral, oral, and feeding tube routes in accordance with the UW Health Clinical
Practice Guideline Medication Route Interchange – Adult – Inpatient or Medication Route Interchange –
Pediatric – Inpatient.

Who May Carry Out This Delegation Protocol:
Pharmacists trained in the use of this protocol.

Guidelines for Implementation:
1. As part of order verification and daily medication profile review; pharmacists will assess the appropriateness
of ordered medication routes. In addition, the patient’s nurse may identify and communicate to the
pharmacist the need for a change in route.
2. If a change in route is indicated, and the patient meets criteria in the UW Health Clinical Practice Guideline
Medication Route Interchange – Adult – Inpatient or Medication Route Interchange – Pediatric – Inpatient,
then the pharmacist modifies the order with order mode “Protocol/Policy without cosign”
3. The pharmacists documents in the order administration instructions the medication has been changed per
protocol.
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
11/2017CCKM@uwhealth.org

4. This protocol may be overridden, at any time, by the prescriber indicating “do not modify per protocol” or
other equivalent wording on the medication order.

Order Mode: Protocol/Policy without cosign

References:
1. UW Health Medication Route Interchange – Pediatric – Inpatient Clinical Practice Guideline
2. UW Health Medication Route Interchange – Adult – Inpatient Clinical Practice Guideline

Collateral Documents/Tools:
1. UW Health Medication Route Interchange – Adult – Inpatient Clinical Practice Guideline
2. UW Health Medication Route Interchange – Pediatric – Inpatient Clinical Practice Guideline

Approved By:
UWHC Antimicrobial Use Subcommittee: May 2013; *September 2015; February 2017
UWHC Pharmacy and Therapeutics Committee: May 2013; *September 2015; February 2017
UWCH Medical Board: June 2013; *September 2015; March 2017

Effective Date: March 2017

Scheduled for Review: March 2020
* Expedited Review Process
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
11/2017CCKM@uwhealth.org