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"When we get enough people who don't care, and who don't accept personal responsibility for high ethical standards, our organization gets the "M" disease: Mediocrity. Anybody can be a carrier. By the same token, every individual can carry the cure: the ethics of excellence."

- Price Pritchett

On September 6th you lose the ability to provide input to the facility survey. Each survey is confidential to the facility. Please help us by being candid in your answers.

Larry Field DO, MBA CMO


The link to the survey is:





Please review the policy in detail on the Home tab of the Portal. Click "Computerized Provider Order Entry Participation Policy". You can still schedule your one-on-one training with the Education Dept. by calling 351-7394 or x7394. 

**  ALERT **


Beginning Tuesday, August 25th, the Angiotensin Receptor Blocker (ARB) substitution will begin. All ARBs will be substituted with losartan per P&T and MEC approval.




Perioperative Bridging Anticoagulation in Atrial Fibrillation


The BRIDGE study, a randomized controlled trial, finds no benefit of bridging in reducing the risk of stroke or thromboembolism, but bridging increases bleeding.

(NEJM 2015;DOI:10.1056/NEJMoa1501035)


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Last evening the Board of Trustees of MRMC as recommended by the MEC, approved the following policy changes:


1)      Rounding nurses may not enter/place any orders. Rounding Nurses may view orders in MedsTracker.


2)     ARNPs and PAs will now be allowed to perform initial evaluation/consultation(s).  All orders given by the ARNP/PAs, on the initial evaluation(s) only, will need to be verified by an MRMC nurse with the ARNP/PAs sponsoring physician.


Believing in open honest communication and transparency wherever/whenever possible, beginning September 9th and  every second Wednesday of each month, the MRMC dining room conference room has been reserved from 08:00 – 08:30  for “Breakfast with the CMO”. Please join me for coffee, tea, juice and a light breakfast.

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Important Information from the Blood Committee


A new series of articles will be posted on the Physician Portal to highlight various drugs and their management. One of the drugs highlighted in this article is Apixaban. For the entire article, login to Portal, click on the Home tab and look for the article, "Anticoagulants for Blood Mgmt  Comm NOV 18," a box will pop up giving you an opportunity to Open (to read) or Save/Save As (for future reading).


Apixaban (ELIQUIS)

Factor Xa inhibitor


For stroke prophylaxis and systemic embolus prevention in non-valvular a. fib:

                For most patients: 5 mg PO BID

                If SCr > 1.5 and age > 80 yr and/or wt < 60 kg: reduce dose to 2.5 mg PO bid

For DVT prophylaxis after knee or hip replacement surgery:

                For all patients: 2.5 mg PO BID x 12 days (knees)

                                                  2.5 mg PO BID x 35 days (hips) 

For DVT or PE treatment:

                10 mg PO BID x 7 days, then 5 mg PO BID for at least 6 months

For reduction in the risk of recurrent DVT and/or PE after completion of treatment for acute DVT or PE:  2.5 mg PO BID


Half-life: 9-12 hours


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