December 22, 2022

eStar update: Last line antimicrobials to require second signature at Monroe Carell

eStar update about use of last line antimicrobials at Monroe Carell Jr. Children’s Hospital at Vanderbilt:


Why: Appropriate use of last line antimicrobials reduces development of resistant organisms
What: Restricted antimicrobial orders at Monroe Carell will require a second signature from an Infectious Diseases Fellow or attending before the orders become active or the medication is dispensed.
When: 1/4/2023
Who: User placing inpatient orders for restricted antimicrobials
Details: §  Current Process at all times of day or night

1.     Primary team pages ID pager requesting approval

2.     ID reviews and if appropriate, provides verbal approval

3.     ID attending’s name is selected as approving provider in the order

§  New Process

·       During business hours, from 0700 – 2200

1.     Primary team pages ID with request for order

2.     ID grants verbal approval, if appropriate

3.     Primary team places order. This order remains inactive UNTIL

4.     ID team cosigns order. The order becomes active at this point.

5.     Pharmacy receives order and dispenses it.

·       Overnight, from 2200 – 0700

1.     Once orders may be ordered and dispensed for restricted antibiotics needed overnight without a cosign.  ONLY one-time orders for restricted antimicrobials will be ordered and dispensed from the pharmacy WITHOUT prior ID approval or cosign.

2.     After a one-time dose is ordered overnight, a scheduled dose should be put in for the following morning.  A cosign will be provided during business hours in order to make the order active.  If the frequency requires more than one dose to be given during overnight hours, order a second one-time dose.   A cosign is ALWAYS required for orders with a scheduled frequency (q24h, q12h, etc).


·       Meropenem will still be available to the intensive care units and through the sepsis order panel for acute care patients for 48 hours without ID approval.


Required Action(s) Contact Infectious Diseases service pager to cosign restricted antibiotic order.
Remember! Restricted antibiotic orders are not active until cosigned by an ID provider.
Questions? Call to Help Desk at 343-HELP (4357)