The Department of Pharmacy shall prepare/dispense medication for patients requiring latex precautions in a manner that prevents the contact of the medication with any latex containing materials. The Pharmacist shall provide information identifying the latex content in medication/packaging and the procedure for avoiding latex contamination. As directed by Vanderbilt University Medical Center policy all latex allergic or sensitive patients will be designated as latex precaution and will be treated by the same latex free protocol.

To prevent latex sensitive patients from exposure to injectable or intravenous medication/solutions that contains latex allergens. To limit the exposure to latex by pharmacy personnel and patients, therefore decreasing the chance of allergy development. To decrease the supplies used by the Pharmacy Department, which contain latex.

The proliferation of latex containing products poses a health risk to patients. Local reactions are most common, but anaphylaxis can also occur without warning. Routes of exposure may occur through inhalation, but also occur when latex allergens are injected directly through latex covered ports in IV tubing. Such exposures have resulted in sever, systemic allergic reactions. Nursing Policy 30-04-11 pertains to Latex Allergy Management and is found in the Patient Care Resource Manual. A copy of this policy is included in the Latex Policy Book in the Central IV Area, Pediatric Pharmacy and SICU pharmacy.

1. Identification

   When patients require latex precautions, this shall be communicated to the Department of Pharmacy via Wiz order entry or written/verbal communication. This information will be entered into the HBOC computer system.


 
2. Reaction Prevention and Management
    
   1. Pharmacy employees preparing medications for latex precaution patients will wear latex free gloves. Medication stoppers shall be removed from vials before preparing medication doses unless written documentation stating the stopper is latex-free has been obtained from manufacturer. The medications for latex precaution patients will be prepared first when beginning the batch procedure and will be segregated and identified by placing in a blue bin.
   
    
   2. All medications for latex precaution patient will be prepared by the Vanderbilt Pharmacy Department rather than being outsourced.
   
    
   3. All injectable medication orders shall have latex allergy precautions entered on the medication label. If the solution does not contain the term latex-free, latex allergy precautions should be entered manually on the message line. This code is "LA". (Care will be taken to limit the message to one line. This will prevent the printing of a message label that may be separated from the original label.) Use the drug files provided that is for latex precaution patients when available. This information should be highlighted on the label in yellow.
   
    
   4. Medications for latex allergic patients shall be prepared in the Central Pharmacy, SICU Pharmacy, or Pediatric Pharmacy whenever possible. Supplies shall be provided in those areas for the preparation of these medications, including stopper removers. (In areas where the Department of Pharmacy does not prepare/dispense medications, information shall be made available on using proper latex precautions.)
       
      1. Preparation of Medications Already in Solution
         
         1. Remove rubber stopper from medication.
         
         
         2. Withdraw the proper amount of medication using a latex free syringe. These are labeled latex free BD syringes or Terumo syringes.
         
         
         3. Cap with the plastic tip supplied with Terumo syringe, which has been maintained in a sterile manner, or a Monoject cap #682101.
      
       
      2. Preparation of Medications Requiring Dilution when stoppers contain latex
         
         1. Remove rubber stopper from both the diluent and the medication.
         
         
         2. Dilute the medication using a latex free syringe. Cap the syringe with a Monoject tip or the plastic tip supplied, which has been handled with aseptic technique.
      
       
      3. Preparation of Medications for Infusion
         
         1. Medications that are prepared by the pharmacy for infusion shall be dispensed in an Abbott bag whenever possible. The injection port of most Baxter bags has latex.
         
         
         2. If an Abbott bag or latex free Baxter bag is not available, prepare infusion by transferring drug and the diluent to a Baxter evacuated container (150cc, 250cc, 500cc or 1000cc) following the procedure below. (An example would be fentanyl 50 mcg/mL.)
            
            1. Spike the administration port (the port used for administration set) of the IV solution. The injection port on a Baxter bag contain latex, do not pierce port prior to dispensing to a patient. If the additive port is not accessed the solution has not been exposed to latex.
            
            
            2. Add the appropriate volume of IV solution to the evacuated container.
            
            
            3. Remove tops from medication vial, withdraw medication and inject into the evacuated container.
   
    
   5. The total parenteral nutrition needs for a latex precaution patient will be met by using a Baxter Quickmix emergency base TPN. These products contain latex in the injection port; therefore, this port cannot be accessed for latex allergic patients. Refer questions to the nutrition team
   
    
   6. At appointed times designated on the Work Flow Sheet in the IV room, the IV pharmacist will run a report listing the latex precaution patients. Utilizing this report, the pharmacist will review the medications, piggyback, and large volume pathways for any potential risk of latex exposure.
       
      
      1. Injectable medications in the medication pathway will be placed in ziplock bags with stickers affixed that indicate Latex Free or Latex Containing to alert nursing personnel.
      
       
      
      2. Medications in the piggyback pathway will be reviewed for correctness of order including prepared using latex procedures and proper information on labels.
      
       
      
      3. Medications in large volume pathway will be reviewed for proper preparation for latex precaution patient. For instance, no injection port access on latex containing Baxter bags.

A handbook containing latex free product information shall be available in the Central IV room, SICU Pharmacy, or Pediatric Pharmacy. Any additional information concerning the products shall be addressed to the manufacturer and written documentation obtained. This information shall be forwarded to supervisor of each pharmacy area and filed in the handbook along with any reference articles.

Anaphylactic emergency kits will include epinephrine, Benadryl, hydrocortisone, Alupent inhaler. These shall be available in the following areas:
1. The Suremed system for inpatients
2. Each outpatient practice area.

Latex allergy information sheets for patients/families shall be available through the Wiz Order entry system.

Latex allergy information sheets for patients/families shall be available through the Wiz Order entry system.

In areas where Wiz Order is available, the order for latex precautions will be entered into Wiz Order as a drug allergy and will be processed using the orders interface program. Patient's latex allergy or sensitivity shall be documented in the allergy section of the pharmacy supplied MAR.

Note: Stat orders may be entered into the pharmacy system first to expedite the order.

Patient Care Resource Manual 30-04.11  Latex Allergy Management

Manufacturer's specific product information sheets in the Latex Information Handbook.

Manufacturers' reference phone numbers available in the Latex Information Handbook)

Reference: Vol 55 Jul 15 1998 Am J Health-Syst Pharm