Becker's Hospital Review

39 CIO / HEALTH IT • In patients undergoing hemorrhoidectomy, a total of 266 mg (20 mL ) of EXPAREL was diluted with 10 mL of saline, for a total of 30 mL, divided into six 5 mL aliquots, injected by visualizing the anal sphincter as a clock face and slowly infiltrating one aliquot to each of the even numbers to produce a field block. Local Analgesia via Infiltration Dosing in Pediatric Patients The recommended dose of EXPAREL for single-dose infiltration in pediatric patients, aged 6 to less than 17 years, is 4 mg/kg (up to a maximum of 266 mg), and is based upon two studies of pediatric patients undergoing either spine surgery or cardiac surgery. Regional Analgesia via Interscalene Brachial Plexus Nerve Block Dosing in Adults The recommended dose of EXPAREL for interscalene brachial plexus nerve block in adults is 133 mg (10 mL), and is based upon one study of patients undergoing either total shoulder arthroplasty or rotator cuff repair. Compatibility Considerations Admixing EXPAREL with drugs other than bupivacaine HCl prior to administration is not recommended. • Non-bupivacaine based local anesthetics, including lidocaine, may cause an immediate release of bupivacaine from EXPAREL if administered together locally. The administration of EXPAREL may follow the administration of lidocaine after a delay of 20 minutes or more. • Bupivacaine HCl administered together with EXPAREL may impact the pharmacokinetic and/or physicochemical properties of EXPAREL, and this effect is concentration dependent. Therefore, bupivacaine HCl and EXPAREL may be administered simultaneously in the same syringe, and bupivacaine HCl may be injected immediately before EXPAREL as long as the ratio of the milligram dose of bupivacaine HCl solution to EXPAREL does not exceed 1:2. The toxic effects of these drugs are additive and their administration should be used with caution including monitoring for neurologic and cardiovascular effects related to local anesthetic systemic toxicity. • When a topical antiseptic such as povidone iodine (e.g., Betadine ® ) is applied, the site should be allowed to dry before EXPAREL is administered into the surgical site. EXPAREL should not be allowed to come into contact with antiseptics such as povidone iodine in solution. Studies conducted with EXPAREL demonstrated that the most common implantable materials (polypropylene, PTFE, silicone, stainless steel, and titanium) are not affected by the presence of EXPAREL any more than they are by saline. None of the materials studied had an adverse effect on EXPAREL. Non-Interchangeability with Other Formulations of Bupivacaine Different formulations of bupivacaine are not bioequivalent even if the milligram dosage is the same. Therefore, it is not possible to convert dosing from any other formulations of bupivacaine to EXPAREL and vice versa. Liposomal encapsulation or incorporation in a lipid complex can substantially affect a drug's functional properties relative to those of the unencapsulated or nonlipid-associated drug. In addition, different liposomal or lipid-complexed products with a common active ingredient may vary from one another in the chemical composition and physical form of the lipid component. Such differences may affect functional properties of these drug products. Do not substitute. CLINICAL PHARMACOLOGY Pharmacokinetics Administration of EXPAREL results in significant systemic plasma levels of bupivacaine which can persist for 96 hours after local infiltration and 120 hours after interscalene brachial plexus nerve block. In general, peripheral nerve blocks have shown systemic plasma levels of bupivacaine for extended duration when compared to local infiltration. Systemic plasma levels of bupivacaine following administration of EXPAREL are not correlated with local efficacy. PATIENT COUNSELING Inform patients that use of local anesthetics may cause methemoglobinemia, a serious condition that must be treated promptly. Advise patients or caregivers to seek immediate medical attention if they or someone in their care experience the following signs or symptoms: pale, gray, or blue colored skin (cyanosis); headache; rapid heart rate; shortness of breath; lightheadedness; or fatigue. Pacira Pharmaceuticals, Inc. San Diego, CA 92121 USA Patent Numbers: 6,132,766 5,891,467 5,766,627 8,182,835 Trademark of Pacira Pharmaceuticals, Inc. For additional information call 1-855-RX-EXPAREL (1-855-793-9727) Rx only March 2021 Hackensack Meridian CIO discusses system's switch from Microsoft to Google By Katie Adams E dison, N.J.-based Hackensack Meridian Health completed a remote work optimi- zation process in 2021 that involved adopting Google's cloud platform and replac- ing Office 365 with Google Workspace, Computerworld reported Dec. 30, 2021. Mark Eimer — Hackensack Meridian's senior vice president, associate CIO and chief technology officer — told Computerworld that the system purchased 3,000 Chrome- books at the beginning of the pandemic so that employees who were not providing direct patient care could work from home. e Chromebook rollout was successful and led to an increase in telehealth visits, ac- cording to Mr. Eimer. He said the system plans to make its hybrid-remote strategy long term and will continue rolling out Chrome OS devices across all Hackensack Meridian hospitals beginning in January. Mr. Eimer said a major reason the system switched to Chrome OS devices is because they're less targeted for ransomware attacks compared to Windows devices. e system also switched all 40,000 of its employees from Microso's Office 365 to Google Workspace. Mr. Eimer said Hackensack Meridian uses most apps in the Work- space suite, including Docs, Meet and Chat. "By the end of 2022, we will be one of the few, if not the only, large integrated delivery health networks that have rolled out Google Workspace and Chrome OS across the board," Mr. Eimer told Computerworld. n Henry Ford Health using EHR to screen for human trafficking victims By Georgina Gonzalez A n EHR system used by Detroit-based Henry Ford Health System is help- ing staff identify victims of human trafficking. In its first two years implementing the program, the system recognized 39 victims, website EpicShare reported Jan. 17. Medical professionals and staff members in the emergency department at Henry Ford were trained to identify victims of human trafficking using such signs as patients telling inconsistent stories, not holding their own ID or money, and the patient's companion answering questions for the patient. If a staff member suspects a patient is a victim, the staffer is instructed by the Epic EHR system to fill in details supporting the assessment. The staffer is then responsible for informing a government body of a possible human trafficking case, and if able, a department social worker meets with the patient for further questioning and support. Given the success of the program, in 2021 Henry Ford adopted it at all of its outpatient clinics.n

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