Bar-Coded Medication Preparation for Chemotherapy [article]

The September 2014 issue of Pharmacy Purchasing & Products contains an article on the use of bar code scanning during the preparation of compounded sterile products (CSPs).  The article touches on some of the topics that Mark and I cover in our report, In the Clean Room; errors in the IV room, bar code scanning during medication preparation, image capture, remote verification, and so on.

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Lexicomp’s new Drug ID mobile module [video]

Lexicomp has a new Drug ID module for their suite of mobile applications.

Based on the Tweet I thought the new application would identify “loose drugs” with the camera on a mobile device like Medsnap, but that’s not the case.
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In the Clean Room: A Review of Technology-Assisted Sterile Compounding Systems in the US [report]

For the better part of the past year I’ve been working on a project with Mark Neuenschwander of The Neuenschwander Company looking at technologies used in pharmacy clean rooms to prepare sterile compounds.

The research into this area took much longer than originally anticipated. We discovered along the way that this subject is much more complex than it appears on the surface. Information is difficult to find, some of the technologies are little more than marketing material on a company website, and the subject matter is in its infancy.
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Saturday morning coffee [October 4, 2014]

“Keep true, never be ashamed of doing right, decide on what you think is right and stick to it.” ~George Eliot

So much happens each and every week that 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….

The mug below comes straight from a little shop in the French Quarter in New Orleans. My wife and I were recently there for a few days while I attended a conference. We had a great time. The food, the people, the atmosphere, all good. We ate a lot of good food, include beignets and my first ever muffaletta.

MUG_NOLA2
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The yin and yang of mobile healthcare

My “swag bag” from the unSUMMIT contained an issue of Specialty Pharmacy Continuum, a throw-away pharmacy journal focused on specialty pharmacy practice. Like most throw-away pharmacy journals I read these days, I found the content timely and interesting.

One of the articles – Get Appy! New Tech a Bridge to Patient Care – discusses how Avella Specialty Pharmacy is using mobile technology to connect with their patients. Apparently Avella is pretty forward thinking.
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The illusion of multitasking

Yesterday I went through the drive-thru of a local fast food chain. The young lady manning the register asked for my order, so I started giving it to her. She asked me to pause for a second, and when she resumed she repeated the first part of my order back to me. She had it completely wrong. This happens to me all the time in the drive-thru, which is why I typically avoid them at all cost. Yesterday I made an exception and instantly regretted it.

People working drive-thru windows at fast food joints typically try to multitask, i.e. take an order from one person while trying to put an order together for another, and so on. In my experience this usually results in what happened to me yesterday. Frequently I have to repeat part, if not all, of my order. I find it quite irritating.

Multitasking is a myth, plain and simple. People do not have the mental capacity to concentrate on more than one thing at a time. Don’t take my word for it. There’s plenty of evidence to back up my claim.

Christopher Chabris, PhD is a professor, research psychologist, and coauthor of the best-selling book The Invisible Gorilla. His research focuses on two main areas: how people differ from one another in mental abilities and patterns of behavior, and how cognitive illusions affect our decisions. He has published papers on a diverse array of topics, including human intelligence, beauty and the brain, face recognition, the Mozart effect, group performance, and visual cognition. He was also the keynote speaker at the unSUMMIT that I attended last week. The presentation was fantastic.

According to Dr. Chabris everyone thinks they can multitask, but very few can. His research estimates that a mere 2.5% of people can “do ok as a multitasker”. Unfortunately his research has demonstrated that everyone thinks they can multitask, and those that consider themselves true multitaskers tend to do the worst in experiments that require one’s attention.

Everything that Dr. Chabris spoke about applies to pharmacy, but I found two things particularly interesting:

  • Post completion errors – this is when someone forgets to complete the last step of a process. Examples include leaving an original paper on a copy machine, or in healthcare, when someone leaves the guide wire from a PICC insertion in place. Even when people are told they forgot the final step they often can’t figure out what went wrong. Dr. Chabris refers to this as “satisfaction of search”, i.e. you see what you expect to see. This type of thing happens all the time in pharmacy practice, especially during the distribution process and the IV room.
  • “Illusion of attention” – this is when people think they can pay attention to multiple things at once. He refers to this as an “everyday illusion”, of which multitasking is a prime example. These misconceptions are hard to overcome and systematically wrong. How many times have you witnessed a pharmacist or pharmacy technician trying to do more than one thing at a time – talk on the phone while filling a script, retrieve tablets from a “Baker cell” while on the phone, etc? Happens all the time.

Overall the presentation was solid and the information valuable. I recommend taking a look at Dr. Chabris’ work. The concepts can be applied both directly and indirectly to errors that occur in the pharmacy.

Technology-Assisted Sterile Compounding Systems [Presentation]

Here’s the slide deck that I used at the unSUMMIT in New Orleans on Saturday, September 20, 2014.

The presentation covered the dangers associated with injectable ADEs, a brief overview of the current state and federal regulation in hospital IV rooms, and a high level overview of automation and technology available to help with compounding sterile preparations.

Note: The deck here has a different title slide. The previous title “Help Navigating the Sea of BCMP – Bar Code Medication Preparation” was changed to “Technology-Assisted Sterile Compounding Systems” after the slide deck was submitted to the unSUMMIT. I also removed the “disclosure” and “learning objective” because they’re useless.

Slide 14 is a video showing a robotic system preparing an IV, which does not run in the slide show below.

I used a telemedicine service for the first time and loved it

My daughter woke the other morning with the following complaints:

  • itchy eye
  • watery eye
  • “feels like there’s sand in my eye”
  • and from my observation, redness in the “white” of her eye

Hmm, I’ve seen this before. My initial thought was conjunctivitis, a.k.a. “Pink eye”.  I called our family pediatrician looking for something to hold us over the weekend until we could be seen on Monday. Basically I was saying it looks like Pink eye, so let’s  treat it like Pink eye for the rest of the weekend and I’ll follow up with you on Monday. Unfortunately I got the nurse practitioner on call. She wasn’t very cooperative. She wanted me to take my daughter to the urgent care to rule out periorbital cellulitis. Really? You jump from itchy, red eye with a slight watery discharge to periorbital cellulitis? I thought that was rather ridiculous, so I ignored her and hung up the phone.

Sounded like a good time to try a telemedicine service. My insurance company, Anthem Blue Cross, offers a a service called LiveHealth Online. I followed the link provided by my insurance company, downloaded the app, and by 7:30 am on Sunday morning my daughter and I were sitting on the couch in our living room speaking with a Family Practice physician about her eye.

I let my daughter do all the talking. I was simply there to make sure things went smoothly. The physician asked several questions about how my daughter was feeling, about her eye, who she’d been in contact with, and what she had been doing over the past several days. The physician had my daughter hold her eye up to the front facing camera on her Galaxy S5 from several different angles to better view of the eye. Conclusion? Conjunctivitis, probably viral. The physician decided to treat with some anti-bacterial eye drops “just in case”. A prescription was electronically sent to our pharmacy and that was it. From beginning to end the entire visit took less than 15 minutes.

It’s been about 36 hours since we started treatment and her eye has improved significantly. Overall I have to say that my first experience with telemedicine was fantastic. A trip to the urgent care would have taken several hours and been quite inconvenient. I have to say, I believe now more than ever that telemedicine has a place in healthcare, especially for things like this.

Periorbital cellulitis my rear.

Saturday morning coffee [September 13 2014]

“The illiterate of the 21st Century will not be those who cannot read or write, but those who cannot learn, unlearn, and relearn.” -Toffler

So much happens each and every week that 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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