Protocols Requiring Clinical Review¶

The following protocols have discrepancies between the reference spreadsheets (Med Chart 2021 and Medication List 2021), calculation concerns, or conflicts that require review by the clinical team before the protocol can be finalised.

1. Amoxicillin / Ampicillin — SPT Concentration¶

Issue: The two spreadsheets disagree on both the SPT concentration and the IDT dilution series. Med Chart 2021 specifies a 1:5 dilution for SPT (20 mg/mL) and IDT at 1:10 and 1:5, while the Medication List specifies neat (100 mg/mL) for SPT and IDT at 1:100 only.

Current page status: Updated to follow Med Chart 2021 (authoritative source). Medication List alternative noted in page Notes.

Action required: Confirm which SPT concentration and IDT range is clinically correct.

2. Augmentin — Formulation and Concentrations¶

Issue: The page previously used a 1.2 g vial (1,000 mg amoxicillin + 200 mg clavulanate) reconstituted to 60 mg/mL. Med Chart 2021 references a 500 mg formulation reconstituted to 10 mg/mL, with SPT at 1:5 (2 mg/mL) and IDT at 1:100 and 1:50.

Current page status: Updated to follow Med Chart 2021 (500 mg formulation). The 1.2 g alternative noted in page Notes.

Action required: Confirm the correct stock formulation (500 mg vs 1.2 g) and verify the resulting test concentrations.

3. Tazocin — SPT Concentration Calculation¶

Issue: The page calculates 1:10 of 200 mg/mL = 20 mg/mL Piperacillin. The Medication List 2021 spreadsheet specifies SPT at 1:10 (2 mg/mL). This is a 10× discrepancy that suggests either: - The spreadsheet uses a different starting concentration, or - There is an error in one of the values.

Current page status: Updated to reflect the spreadsheet value (2 mg/mL). The calculation discrepancy is flagged on the page.

Action required: Verify the correct SPT concentration. If 2 mg/mL is correct, the starting stock concentration or dilution factor needs clarification.

4. Pantoprazole — Spreadsheet Labelling Error¶

Issue: The Medication List 2021 spreadsheet labels the SPT concentration as "Neat (40 mg/mL)". However, reconstituting a 40 mg powder vial with 10 mL NS yields 4 mg/mL, not 40 mg/mL. The page calculation is correct; the spreadsheet has a labelling error.

Current page status: Page retained as-is (4 mg/mL is correct). Discrepancy noted in page Notes.

Action required: Correct the Medication List 2021 spreadsheet to read "Neat (4 mg/mL)" instead of "Neat (40 mg/mL)".

5. Ketamine — IDT Range¶

Issue: Three different sources give three different answers: - Med Chart 2021: IDT at 1:1,000 only (most conservative) - Medication List 2021: IDT at 1:100 - Spreadsheet note: ANZZAG specifies 1:1,000 as initial and max; department protocol uses 1:100 and 1:10

Current page status: Updated to follow Med Chart 2021 (1:1,000 only). All alternatives noted in page Notes.

Action required: Confirm the correct IDT range. Determine whether the department protocol (1:100, 1:10) supersedes the Med Chart, and whether ANZZAG guidance should take precedence.

6. Ropivacaine — IDT Range¶

Issue: Med Chart 2021 specifies IDT at 1:10 only for the GA (general anaesthetic) test. The Medication List 2021 specifies a much fuller dilution series (1:1,000 → 1:100 → 1:10 → Neat).

Current page status: Updated to follow Med Chart 2021 (1:10 only). Medication List alternative noted in page Notes.

Action required: Confirm whether the fuller IDT series is needed for certain clinical scenarios (e.g., local anaesthetic allergy testing vs GA testing).

Summary¶