Pre-mixed piperacillin / tazobactam 4.5g in NaCl 0.9% bags
Successful management of sepsis is time sensitive, timely intervention may be lifesaving.
To provide prompt administration when following the Sepsis and Septic Shock Standard Orders, piperacillin / tazobactam Injection 4.5 g in NaCl 0.9% pre-mixed bags will be available at BRHC, BTHC and PDGH / PRHC. Pre-mixed bags should be prioritized for loading doses only. Fresenius Kabi compounded bags are stable for 28 days and may be kept at room temperature. Occasionally, when product is nearing the Beyond Use Date, stock may used for indications outside of the Sepsis protocol to prevent waste.
Vials of piperacillin / tazobactam 4.5 g will be available for use with all other indications. Vials are compatible with Mini-bag Plus.
Piperacillin / Tazobactam Injection 3.375 g in NaCl 0.9% pre-mixed bags, will not be available. This will align with other SDO in Manitoba where vials are currently the sole source of piperacillin / tazobactam 3.375 g. Any remaining supply of the 3.375 g bags will not be replaced once depleted.
Thank you for your support in ongoing efforts to manage drug supply issues.
For questions, please contact your site pharmacy Or contact Rizwan Ahmed or Libby Gair
Submitted by: Rizwan Ahmed – Regional Pharmacy Director
Clinical Note – Pre-printed MARs for Standard Orders in Acute Care
PURPOSE: Pre-printed MARs improve the efficiency and safety of medication transcription and administration.
Pre-printed MARs for standard order sets in acute care were developed during the implementation of computer-generated MARs (cMARs) at acute care facilities and trialed in draft form.
All pre-printed MARs are now approved and posted on StaffNET
If you have any questions, please contact your Manager, Director or Educator
NT-proBNP Testing
Date effective: April 7, 2026
Background Information:
NT-proBNP has a very high diagnostic accuracy in discriminating heart failure (HF) from other causes of dyspnea: the higher the value, the higher the likelihood that dyspnea is caused by HF.
NT-proBNP testing can be considered for patients presenting with atraumatic dyspnea without obvious cause, where history, physical exam, CXR and POCUS are not diagnostic or not available.
Perioperative NT-proBNP is a prognostic indicator for post-surgical outcomes and can be used to identify high risk patients and plan care appropriately.
Change in Test Procedure:
Effective April 7, NT-proBNP testing will be available to both hospital and community patients. On-site NT-proBNP testing will be available at Brandon Regional Health Centre/Westman Lab, HSC and SBH.
Over the next 6 months, a phased role out of on-site NT-proBNP testing will occur for Grace Hospital, Seven Oaks General Hospital, Dauphin General Hospital, Bethesda Regional Health Centre, Selkirk & District General Hospital, Portage Hospital, Thompson General Hospital, The Pas Health Complex (St. Anthony), Boundary Trails Health Centre, Swan Valley Health Centre, Flin Flon General Hospital, Victoria General Hospital, Concordia Hospital, and Neepawa. Role out at some sites is pending analyzer upgrades that are underway.
Order by writing NT-proBNP or the lab code NBNP on the laboratory requisition you use for ordering chemistry tests.
Where testing is available on site, results for hospital patients will be available within 2 hours of the laboratory receiving the sample in lab.
Samples collected at a non-testing site will be sent by routine courier to a laboratory that provides this testing. Turnaround time will vary depending on collection site and courier routes.
Cautions:
NT-proBNP is a marker of myocardial stress, as such may be elevated among patients with severe respiratory illnesses typically in the absence of elevated filling pressures or clinical heart failure.
Patients with heart failure and obesity show lower than expected NT-proBNP results.
Laboratory Reports provide age specific cutoff values indicating probability of Heart Failure in adults. These are not “normal” reference values. In healthy individuals NT-proBNP results are dependent on age (young children and older adults have higher values), gender (females have higher values then males) and body size.
NT-proBNP cannot identify the underlying cause of HF and, therefore, if elevated, must always be used in conjunction with cardiac imaging.
NT-proBNP measurements should always be used in conjunction with all other clinical information.
Patient Impact:
Improve diagnosis and treatment for patients with symptoms of heart failure
NT-proBNP available for patients in the community
System Improvements:
Improved access and turnaround time for NT-proBNP testing.
Ezekowitz JA, et al. 2017 Comprehensive update of the Canadian Cardiovascular Society Guidelines for the management of heart failure. Can J Cardiol. (2017) 33(11):1342-1433.
Kozhuharov N, et al. Clinical effect of obesity on N-terminal pro-B-type natriuretic peptide cut-off concentrations for the diagnosis of acute heart failure. European Journal of Heart Failure (2022) 24, 1545–1554
Welsh P, et al. Reference Ranges for NT-proBNP (N-Terminal Pro-B-Type Natriuretic Peptide) and Risk Factors for Higher NT-proBNP Concentrations in a Large General Population Cohort. Circ Heart Fail. (2022) Oct;15(10):e009427.
Canadian Cardiovascular Society Guidelines on Perioperative Cardiac Risk Assessment and Management for Patients Who Undergo Noncardiac Surgery. Can J Cardiol 2017:22;17-32
Authorship/Endorsements: Dr. Laurel Thorlacius PhD, FCACB, Medical Director, Clinical Biochemistry, Diagnostic Services, Shared Health, Dr. Shelley Zieroth FRCPC, Professor, University of Manitoba, Director Heart Function Clinic, Cardiac Sciences Manitoba Dr. Paul Ratana LLB, LLM, MD, FRCPC, Head, Department of Emergency Medicine, University of Manitoba, Provincial Specialty Lead, Emergency Medicine, Shared Health Dr. Bojan N. Paunovic MD, FRCPC, Provincial Medical Specialty Lead – Adult Critical Care – Shared Health, WRHA Medical Specialty Lead – Adult Critical Care, Section Head – Critical Care – Dept. of Internal Medicine, Assistant Professor – University of Manitoba, Site Critical Care Lead – Health Sciences Center – Winnipeg
All updated SPHP supporting documents, Safe Work Procedures (SWPs) and videos are accessible through the SPHP Index on the website.
A QR poster has been introduced to provide quick and convenient access to the index. This will replace the SCHIPP binder. Please ensure that all outdated SCHIPP binders are removed from your sites.
Submitted by: Krista Schaan, Musculoskeletal Injury Prevention Education Facilitator
ACETYLSTEINE | Provincial Documents
Effective April 1, 2026, the MB/ON Poison Control Centre Acetaminophen Toxicity Protocol has been updated. The new Provincial Treatment of Acetaminophen Toxicity will go live, and the approved documents listed below will be posted at Document Library – Provincial Documents.
600.105.121-OS Acute Acetaminophen Toxic Ingestion Adult or Pediatric Provincial, Provincial Order Set
600.105.121-OSR-01 Management of Acetaminophen Toxic Ingestion in Adult and Pediatric Patients: Supplementary Resource to Acetaminophen Toxic Ingestion Order Set
600.105.121 Management of Acetaminophen Toxic Ingestion in Adult and Pediatric Patients
Submitted by: Tamara Burnham, Collaborative Practice Lead
Elsevier Password Update
The generic Elsevier password has changed.
In order to access Elsevier from a mobile device or remotely please expand for more details under the Elsevier flipbox on this page or see below:
Username: SH-SS Password: Health204
Elsevier is a clinical resource that is available to Southern Health-Santé Sud clinical staff. It is Southern Health-Santé Sud’s primary clinical best practice reference, and is accessible electronically via desktop icon without log-in , and via remote and mobile access (where the log-in credentials above are required). It is intended to support standardized clinical practice across all disciplines within all programs, and to inform SH-SS policy, procedure, guideline and program development.
Access to Elsevier can be found on your desktop home screen, or by using the following link.
Submitted by: Staff Development, Infection Prevention & Control
Documents are being circulated to Southern Health-Santé Sud (SH-SS) clinical teams to prepare for the April 1, 2026 go-live for the Provincial Treatment of Acetaminophen Toxicity in alignment with the Ontario Poison Centre change.
The following provincial clinical documents will be active in SH-SS starting April 1 at 10:30am, at the same time the SH-SS BBraun Infusomat acetylcysteine drug library update occurs. DO NOT remove old paper documents and replace with the new ones until then. Documents will be available for printing on the Shared Health Document Library – Provincial Documents site on April 1. The current SH-SS Acetaminophen Overdose Treatment Standard Orders will be archived and links to new provincial clinical documents will be added on SH-SS StaffNET Policies & Forms for future access.
SH-SS Staff Development encourages staff to attend the Ontario Poison Control training sessions (details in Shared Health March 20, 2026 memo). Site Educators will connect with staff and use additional resources to support learning and track education. Attached education resources are available for sites to use:
Drug Library Update reports will be distributed to sites/programs as part of the tracking and validation to confirm updates occur in all pumps.
Staff are encouraged to direct any questions and concerns to their manager/supervisor.
Submitted by: Tamara Burnham, Collaborative Practice Lead
Discontinuation of Urinalysis Bilirubin and Urobilinogen
Effective March 30, 2026, all Shared Health Biochemistry Laboratories will discontinue offering dipstick Urine Bilirubin and Urobilinogen as reportable tests from urinalysis dipstick panel. When ordering urinalysis, the following analytes will continue to be reported: Glucose, Ketones, Specific Gravity, Blood, pH, Protein, Nitrite and Leukocytes.
Background:
Urine bilirubin and urobilinogen dipstick tests have poor analytical sensitivity and specificity. There is a high proportion of false negative results due to instability of bilirubin and urobilinogen to light and temperature, and false positive results encountered due to urine color.
Plasma test for total bilirubin has superior sensitivity and better analyte stability.
References:
Foley KF, Wasserman J: Are unexpected positive dipstick urine bilirubin results clinically significant? A retrospective review. Laboratory Medicine 2014; 45: 59.
Binder L, Smith D, Kupka T and al.: Failure of prediction of liver function test abnormalities with the urine urobilinogen and urine bilirubin assays. Archives of Pathology and Laboratory Medicine 1989; 113: 73.
Contact Information:
Hana Klassen Vakili, DABCC, FCACB, Clinical Biochemist Laurel Thorlacius FCACB, Medical Director, Clinical Biochemistry
PLEASE SHARE THIS MESSAGE WITH HEALTH CARE PROVIDERS AND OTHER RELEVANT INDIVIDUALS.
Submitted by: Loreley Fehr, Director, Health Services – Public Health-Healthy Living
Transfusion Manitoba Website Update
Blood Management, Shared Health, has recently updated the Transfusion Manitoba website to enhance usability. Key improvements include repairing broken links, reorganizing the product monograph page, and adding a calendar of transfusion-related events. The Transfusion Manitoba icon has also been added to all SDO shortcut pages for easier access to transfusion resources.
Please report any non-functional links or missing transfusion-related information to [email protected]. Inquiries will be directed to the appropriate contact for follow-up.
