Optimizing patient safety by preventing combined use of intramuscular olanzapine and parenteral benzodiazepines

Abstract

A formalized policy was developed to warn of the potential for adverse events associated with the use of intramuscular olanzapine in combination with injectable benzodiazepines. Administrators in the psychiatry department at Lutheran Hospital proposed that concomitantly active orders for both intramuscular olanzapine and parenteral benzodiazepines be prohibited as a matter of policy; this decision was supported by the institution's pharmacy and therapeutics and medical executive committees. The pharmacy department subsequently examined its processes as they related to the two medications, and changes were implemented in the areas of order processing and floor-stock provision. Before policy implementation, injectable olanzapine was stored as floor stock in several automated medication cabinets for use in urgent situations. Injectable lorazepam was also included in the stock inventory for most patient care areas. After policy implementation, intramuscular olanzapine was removed from the general floor stock on all hospital units. The drug is now only available after a pharmacist's review and approval of each individual order. Upon receipt of an order for intramuscular olanzapine, the pharmacist is required to conduct a prospective review of the individual patient's medication profile to determine if an active order for an injectable benzodiazepine exists. In the event that the prescriber cannot be reached in a timely fashion, the new order is held until a physician's clarification can be obtained. Implementation of a policy that increased pharmacist surveillance and regulation of the use of intramuscular olanzapine reduced the potential for coadministration of the agent with parenteral benzodiazepines in a community hospital.