ALL TCAs and Paroxetine are on the AGS Beers Criteria list for patients above the age of 65. Given this these medications can no longer be ordered directly through the medication ordering menu and must be ordered by completing the TCA/Paroxetine note, this can be done as follows:
Go to Notes (bottom tab) -> New Note (bottom left side of screen)-> TCA/PAROXETINE OUTPATIENT PRESCRIPTION
One of two things will happen:
A. If the patient is under 65 they will not need an assessment and it will automatically go to the ordering screen where you can order the TCA or the Paroxetine (remember that if the patient is new to an antidepressant for depression, they must have an assessment by a psychologist/RN in 30 days to ensure they are tolerating well before the medication can be renewed)
* In this scenario order the medication and delete the note
* EKG should be obtained when starting the medication to evaluate for QT prolongation
EKGs should also be done within several weeks after dose increases to ensure that QT prolongation does not occur.
B. If the patient is 65 or above as assessment will pop up asking that you have educated the patient on the risks of this drug and performed a medication
reconciliation. You will have to complete all the questions in sequential order to complete the note. Once the note is complete the menu for ordering the TCA or paroxetine will pop up allowing you to order the medication
* Again, please note that if this is a new prescription the patient will need follow up with psychology in 30 days to ensure that the patient is tolerating the medication well before renewing.
* EKG should be obtained when starting the medication to evaluate for QT prolongation
EKGs should also be done within several weeks after dose increases to ensure that QT prolongation does not occur.
Note: If the patient is using the medication for pain instead of depression they do NOT need follow up with psychology however they will need the EKG monitoring done. Your note will also have to clearly state that this medication is being used for pain and not depression.
If the patient is not following regularly with psychology or psychiatry please enter a Behavioral Health Consult for antidepressant monitoring. This enrolls the patient in a program during which a nurse will call the patient every 30 days to assess their response to the antidepressant until they are stable, this nurse will alert you if the patient would benefit from a dose adjustment or medication change.