Our hospital uses "clinical guidelines" which are preprinted orders for certain things. ACS is a very common one that we see everyday. One of the orders is Lovenox 30mg IV, then 1mg/kg SQ a 12h. Sometimes this is started in ER, the lovenox IV and SQ are both given before the patient arrives to the unit. I, and many of my coworkers have always assumed this was how it was meant to be given. An IV bolus, which acts quickly but only lasts a short time, followed immediately by a SQ dose which takes 2-4 hours to reach peak effectiveness.
My problem is, I found that there are some people (a pharmacist included) who believe the itent is to give the IV dose, then start the SQ 12h later. I talked to 1 cardiologist who said he doesn't order it IV - actually it was the PA, and he didn't know WHY the Dr doesn't like IV. Even the other pharmacists were clueless.
I could not find anything helpful in the PDR, or on our hospital medication site. I asked 2 ER docs who said they don't use the ACS orders because they don't believe Lovenox should be given IV. So, do any of you have any orders for Lovenox IV followed by SQ, and how is it given in your hospital? At the same time, or delayed? Also does anybody know how long until the IV form is ineffective?
