Therapeutic substitutions (T-subs)

What’s wrong with this picture?

• All Therapeutic substitutions (T-subs) must be built manually by our Pharmacy IT department (for multiple environments), and not all are. When this is the case, dose and other mismatches may occur.

​

• Please look for (No Exact Match) on the initial T-sub screen, and carefully review the substitution using a two-step process prior to clicking OK

Example: “(No Exact Match)”: indicates t-sub likely not fully built out

In this example, not every two tablet dose increment of Crestor was built out to substitute correctly, and the patient was under-dosed as a result. This has now been fixed.

Step 1: Compare the 1^st line to the 3^rd line (the 1^st line reflects the original order)

Step 2: Compare the 2^nd line to the 3^rd line (this is the P&T approved substitution, as expressed on Formweb)

Sometimes when t-subs aren’t built out, providers are presented a pick screen: (e.g. G-tube route at home, every other day frequency). Providers should be conscientious and pick correctly

5

Recent Med Error Example

• A patient’s home Suboxone was continued inpatient but was incorrectly auto-subbed from the film bid to the tablet daily.
• The bid frequency interchange was not built so the prescriber had to manually select a frequency and incorrectly selected daily. The order was verified by the pharmacist.
• A second pharmacist corrected the interchanged frequency to bid later that day.

​

Bottom line: T-subs

• Always check Therapeutic Interchange details when ordering
• If you see (No Exact Match), carefully review the T-sub as you may need to adjust the final order
• We need your help reviewing T-subs. Report problems for us to consider building
• If there is an intentional dose change, consider indicating this in Order Comments

7