Antimicrobial Use Guidelines (AMUG) version 21 - UW Health

2.1.7 Patient is without placement of a feeding tube and is somnolent and unableto protect airway.2.1.8 Patient is at risk for aspiration and does not have a feeding tube in place.2.1.9 Patient requires continuous gastric suctioning.3.0 Enteral (Oral to Feeding Tube – Feeding Tube to Oral)All medication orders with an enteral route of administration are eligible for thisinterchange. An initial medication order must be documented in the medical record toinitiate this protocol. The pharmacist will modify the medication order based on the belowinclusion criteria and evaluation of assessment criteria.3.1 Feeding Tube to Oral Inclusion CriteriaTo initiate a feeding tube to oral interchange the patient must have passed aswallow study.3.2 Oral to Feeding Tube Inclusion CriteriaTo qualify for the oral to enteral interchange an enteral feeding tube must be inplace and cleared for use with documentation of appropriate placement.3.3 Assessment Criteria3.3.1 Evaluation of available alternative dosage forms including an assessment offormulation appropriateness.3.3.2 Assessment of pharmacokinetic parameters including the site of drug action,bioavailability, absorption characteristics and the effects of food on drugabsorption.3.3.3 Evaluation of the type of feeding tube and placement location within thegastrointestinal tract.3.3.4 Assessment and modification of dosage and/or frequency if therapeuticallywarranted (i.e. phenytoin capsules to phenytoin suspension). A pharmacist isalso permitted to modify an extended release product for an immediaterelease product. (i.e. depakote to valproic acid solution; mycophenolatesodium EC tablet to mycophenolate mofetil suspension)C. Documentation4.1 Medication orders meeting the above criteria for the change in the route ofadministration are subject to interchange as soon as the patient meets the establishedcriteria.4.2 Once a patient meets the criteria, the pharmacist will discontinue the currentmedication order and automatically convert the medication to the appropriatecorresponding dosage form by placing an order in the electronic medical record.4.3 The pharmacist will document this change in the administration instruction section ofthe medication order by indicating “Modification made per medication routeinterchange protocol”.4.4 Orders will be processed using the per protocol without cosign ordering mode.