Saturday morning coffee [January 24 2015]

“There is a fundamental question we all have to face. How are we to live our lives; by what principles and moral values will we be guided and inspired?” - H. Jackson Brown, Jr.

So much happens each and every week, and it’s hard to keep up sometimes. Here are some of the tabs that are open in my browser this morning along with some random thoughts….

MUG_SMC
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Cool Pharmacy Technology – Intelliport Medication System

I briefly mentioned the Intelliport Medication System from BD in a previous post. The technology and potential use cases are impressive.

The BD Intelliport System offers:

  • Drug and concentration information is presented to the user via audio and visual feedback. The system pulls information from the bar code on the syringe as it’s inserted into the Intelliport injection port.
  • Drug identification, dose measurement and drug allergy alerts in real-time. The allergy information is pulled directly from the patient’s EHR record.
  • Automated documentation of medication delivery. The system wirelessly captures drug, dose, time, and route of administration. The information is fed directly back into the EHR

Check the video below, it’s really cool.

Are we seeing the final days of standalone systems in pharmacy?

I’ve used many standalone systems in the pharmacy throughout my career. There was a time when it was considered the norm, but things are starting to change.

I’ve seen a significant shift in thinking over the past couple of years. Hospital pharmacies are tired of dealing with multiple databases, the inability of one system to easily shuttle information to another, and broken interfaces, i.e. “interface is down”. I’ve talked to several pharmacists over the past few weeks that are no longer looking at functionality, but instead are seeking integrated ecosystems to run pharmacy operations. And they’re willing to give up functionality to get it.
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First time using Epic – initial thoughts and impressions

Epic is an Electronic Health Record (EHR) used in hospitals all over the country. If you work in healthcare you know who they are. Epic is the top EHR system in the U.S. and they continue to gobble up market share.

According to the Epic website, the pharmacy information system (PhIS) inside Epic is officially known as the “Willow Inpatient Pharmacy System”. However, I commonly hear it referred to as simply Willow.

Over the span of my 19 year career I’ve used several pharmacy information systems, but never Willow. For whatever reason the hospitals I’ve worked in have used other EHR and/or pharmacy system vendors; GE, Siemens, MEDITECH, IDX, etc. Recently I had the opportunity to spend a couple days learning how to use Willow. I was pretty excited. I’ve heard a lot of good things about Willow, and some bad. I’ve been wanting to get firsthand knowledge for quite some time.

Disclaimer: These are my initial impressions. Two days of training isn’t nearly enough time to learn all the ins and outs of a pharmacy system. I’ve recently accepted a position where I will be using Epic, albeit not in a full-time capacity, so I’m sure that my thoughts and opinions will evolve over time.
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Making the case for bar code medication preparation (BCMP) in sterile compounding

The tragic death of a hospitalized patient in Oregon [1] has once again put a spotlight on pharmacy i.v. rooms. Unfortunately this isn’t the first i.v. error to harm, or kill a patient and I’m sad to say that it probably won’t be the last. We know that IVs present higher risks than most other medications and the literature presents abundant evidence of the prevalence of pharmacy compounding errors which result in patient harm or death.2-11

According to a 1997 article by Flynn, Pearson, and Baker: A five-hospital observational study on the accuracy of preparing small and large volume injectables, chemotherapy solutions, and parenteral nutrition showed a mean error rate of 9%, meaning almost 1 in 10 products was prepared incorrectly prior to dispensing.6

The inherent problem with compounded sterile products (CSPs) is that the efficacy of IV medication administration hinges on the integrity of dose preparation and labeling in the pharmacy. If an item is compounded incorrectly in the pharmacy, no amount of verification at the bedside will alter that. Other than looking at an IV bag or syringe to ensure that no gross particulate matter is present, without chemical analysis it is impossible to verify the contents. Occasionally a color change will acknowledge the addition of the correct additive – yellow multivitamins, red doxorubicin, and so on – but even then, the correct amount (volume/dosage) cannot be verified.
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Should you purchase a robot to help compound sterile preparations in the i.v. room?

The promise of a future where robots handle pharmacy distribution has been around for quite some time. It seems to always be “just a few years away”. I’ve seen my share of robotic distribution systems implemented in pharmacy operations, and the expectation has always been better than the reality.

But what about using robotic systems in the i.v. room to help make sterile preparations? It seems like the perfect place for this type of tool. Activities in i.v. rooms are dangerous and expensive. If one could utilize a robot to increase safety and decrease cost, then it would seem like a no brainer. Unfortunately it’s not as simple as that.

Over the past 16 months I’ve observed several different robots – INTELLIFILL I.V. by Baxter, APOTECAchemo by APOTECA, i.v.STATION by Aesynt, and RIVA by IHS – in several different pharmacy environments – inpatient batch processing for multiple hospitals, inpatient patient specific production for single hospital, inpatient chemotherapy, and outpatient chemotherapy. During that time I’ve formed several opinions about the current crop of i.v. room robots; some good, some not so good.
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Selecting technology for the i.v. room is no easy task

Since In the Clean Room was released in October, I’ve received a lot of questions about i.v. room technology. The questions generally focus on a single product or a particular functionality. However, I get a surprisingly large number of people asking me “what’s the best system for the i.v. room”. A simple question. Unfortunately it’s a question that is not easily answered.

There are several variables to consider when selecting technology for the i.v. room, as well as a number of questions that must be answered during the evaluation process.
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Saturday morning coffee [December 27 2014]

“A man who lives right, and is right, has more power in his silence than another has by his words.” ~Phillips Brooks

So much happens each and every week, and it’s hard to keep up sometimes. Here are some of the tabs that are open in my browser this morning along with some random thoughts….

A package arrived on my doorstep Christmas Eve. That’s not unusual this time of year. However, neither my wife nor I were expecting a package. When I opened it I found two coffee mugs inside with a note that said “We were inspired by your blog post the other day”. Very cool. The mugs were sent by MEPS Real-Time, Inc. A very big thank you to the generous people at MEPS.

MUG_MEPS
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ISMP responds to deadly drug error in Oregon

Last week I wrote about the tragic death of a patient caused by a drug error (CSP error results in death of a patient). One day later on December 18, 2014, ISMP also addressed the error in the Acute Care edition of their biweekly ISMP Medication Safety Alert, i.e. one of their newsletter. I had hoped that ISMP was going to provide much greater detail and insight into the error, but that’s not the case. At least not at this point, anyway.

I had hoped to find out what occurred in the pharmacy to allow such a mistake to happen. Perhaps more details will come to light as time goes on. All we can do is wait.

With that said here are some things from ISMP worth noting:

To prevent inadvertent use, identify neuromuscular blockers available within your organization and where and how they are stored. Regularly review these storage areas, both inside and outside of the pharmacy, including agents that require refrigeration, to consider the potential for mix-ups.

Limiting access to these products is a strong deterrent to inadvertent use. Consider limiting the number of neuromuscular blockers on formulary, and segregate or even eliminate storage from active pharmacy stock when possible.

Restrict storage of paralyzing agents outside the pharmacy and operating room by sequestering them in refrigerated and nonrefrigerated locations.

ISMP recommends highly visible storage container for neuromuscular blockers (one example here: www.ismp.org/sc?id=458).**

ISMP recommends affixing warning labels on vials and admixtures that clearly communicate the dangers of neuromuscular blockers.**

ISMP recommends the use of IV workflow technologies. “Now is the time for hospital leadership to support the acquisition of IV workflow technologies that utilize barcode scanning of products during pharmacy IV admixture preparation.” While the article lists only three systems, there are several on the market [see  In the Clean Room TOC for a current list of many of the available systems].

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**I know that many think this is a good idea, but I’m not so sure that I’m one of them. On the surface, using highly visible storage containers and labels might seems like a good idea, but over time people become used to the idea and become blind to the differences. In addition, over the years the number of items that require alternate storage and labeling has grown, making differentiation “the norm”. It’s like the student that highlights everything in the textbook with five different colors. Eventually the entire book is highlighted, making the process meaningless to the reader.

Saturday morning coffee [December 20 2014]

“Christmas is the spirit of giving without a thought of getting. It is happiness because we see joy in people. It is forgetting self and finding time for others. It is discarding the meaningless and stressing the true values.” ~Thomas S. Monson

So much happens each and every week, and it’s hard to keep up sometimes. Here are some of the tabs that are open in my browser this morning along with some random thoughts….

MUG_Christmas
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