Jerry Fahrni

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Category Archives: Medication Safety

MedKeeper acquires DoseResponse

Posted on October 19, 2010 by Jerry Fahrni
2 Comments

It looks like MedKeeper is making a play in the therapeutic monitoring market by acquiring DoseResponse, a web-based outpatient anticoagulation management system from Keystone Therapeutics. The press release can be found here.

Outpatient anticoagulation therapy, i.e. warfarin management, became a big deal when JCAHO made it one of their national patient safety goals a few years back. I’m specifically referring to National Patient Safety Goal 3E: Reducing Harm from Anticoagulation Therapy. If you feel like giving yourself a headache you can read through the entire Abulatory Health Care National Patient Safety Goals (PDF). I wouldn’t recommend it.
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Categories: Medication Safety | Tags: Cloud Computing, Medication Safety, Patient Safety, SaaS, Therapeutics

More problematic barcodes

Posted on October 12, 2010 by Jerry Fahrni
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Recently I’ve heard of hospitals having problems with barcodes on pre-mixed IV bags. The problem isn’t related to the legibility or quality of the barcodes, but rather the location and/or the information contained within the barcode itself.
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Categories: Barcoding, Medication Safety | Tags: Barcodes, Barcoding, BCMA, BPOC, Patient Safety

Real-time infusate verification with smartpumps. How do we get there?

Posted on September 7, 2010 by Jerry Fahrni
1 Comment

Smartpumps are anything but smart. They provide an extra layer of safety to intravenously administered medications to be sure, but they can only do what we tell them. We build the “drug dictionaries” against which all infusions are measured and we ask those administering the medications to abide by the rules associated with programming and using the pumps. Unfortunately that leaves a lot of room for human error and outright flagrant disregard for processes and procedures. I digress, that’s a different post altogether.

Assuming that the provider responsible for setting up the pump follows the rules, and that the medication is correctly prepared by the pharmacy, then we may assume that the smartpump certainly has the potential to prevent errors that may have otherwise been missed. There are plenty of anecdotal reports out there from hospitals where smartpumps have prevented some pretty significant dosage errors associated with opioids and insulin. Not all these errors would have resulted in patient harm, but it’s eye-opening nonetheless.
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Categories: Medication Safety | Tags: Ideas, Medication Safety, Patient Safety, Smart Pumps

Small labeling changes to phenytoin unit dose cup causes confusion

Posted on August 14, 2010 by Jerry Fahrni
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August 12, 2010 issue of the ISMO Medication Safety Alert the issue of : “We have received a number of reports about the labeling of Xactdose unit dose liquid containers from VistaPharm, Inc., of Birmingham, AL. The company recently changed the way the drug concentrations are expressed on their labels. An example is phenytoin oral suspension which went from emphasizing 100 mg/4 mL to listing 125 mg/5 mL. The company rightly notes that the 125 mg/5 mL container delivers 100 mg or 4 mL (due to the heavy liquid consistency of phenytoin suspension), but the message doesn’t necessarily translate to nurses who are confused by the new label and need to give an exact dose. The good news is, we learned last week that VistaPharm is returning to the old style label. That will no doubt lead to less confusion, but nurses should also know not to rinse the residual suspension from the cup. Doing so would approximate as much as a 25% overdose. The company said they expect to release products with revised labeling by the end of the month.”
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Categories: Medication Safety | Tags: Medication Errors, Medication Safety, Patient Safety

Is the 30-minute rule for medication administration good or bad?

Posted on July 5, 2010 by Jerry Fahrni
5 Comments

The June 17, 2010 issue of ISMP Medication Safety Alert I received has an interesting article on the unintended negative consequences of the Centers for Medicare & Medicaid Services (CMS) regulation requiring medications to be administered within 30 minutes of their scheduled dosing time. I’m sure that the CMS 30-minute rule was created with good intentions in mind, but in reality it creates a lot of anxiety and bad habits. According to the ISMP article, the CMS 30-minute rule “may be causing unintended consequences that adversely affect medication safety. While following the 30-minute rule may be important to hospitals, many nurses find it difficult to administer medications to all their assigned patients within the 30-minute timeframe. This sometimes causes nurses to drift into … unsafe work habits.” Those unsafe work habits include removing meds from automated dispensing cabinets (ADC) for multiple patients at once, removing meds ahead of time, falsifying documentation to meet the 30-minute rule and preparing doses ahead of time; all dangerous practices.
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Categories: Medication Safety | Tags: BCMA, BPOC, CPOE, Medication Errors, Medication Safety, Patient Safety

Cool Technology for Pharmacy – RxVerify

Posted on June 17, 2010 by Jerry Fahrni
2 Comments

While reading through a pharmacy listserv I came across a seemingly simple piece of software that fills an important gap in the pharmacy distribution process. RxVerify, by Pharmacy Ideas, is a bar-code verification system used during the medication restocking phase for code boxes, anesthesia trays, transport boxes, etc.
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Categories: Barcoding, Cool Technology, Medication Safety | Tags: BCMA, BPOC, Medication Safety, Patient Safety

OTC drug interaction analyzer for smartphones

Posted on June 14, 2010 by Jerry Fahrni
4 Comments

Medilyzer is a smartphone application designed to provide mobile information and drug interaction checking for various over-the-counter (OTC) medications. The application is available for both the iPhone and Android smartphones, and according to the Medilyzer website a BlackBerry edition is on its way.
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Categories: Barcoding, Medication Safety | Tags: Android, BCMA, BPOC, Droid, iPhone, Medication Safety, Smartphone

IntelliDose EHR integration

Posted on May 29, 2010 by Jerry Fahrni
2 Comments

CMIO: “Allscripts will integrate IntrinsiQ’s IntelliDose chemotherapy management tool into its EHR product suite as a new offering for physician practices.

The Waltham, Mass.-based IntrinsiQ’s IntelliDose calculates and tracks the administration of chemotherapy treatments and will enable Allscripts’ multi-specialty and oncology clients to manage oncology patient care workflow, according to the company.

Under the agreement, oncology practices will work with Allscripts account managers to coordinate with implementation and training specialists from the IntelliDose team. Integration of IntelliDose into Allscripts tools will enable Allscripts clients to select the add-on program to navigate patient records across both systems, IntrinsiQ stated. “

This sounds like an interesting concept. I tried looking for detailed information on IntelliDose, but really couldn’t find much. Based on information at the IntrinsiQ website it appears that IntelliDose is a clinical decision support system designed specifically for chemotherapy. Based on the description, IntelliDose does many of the same things that a pharmacy information system does, i.e. checks for “body surface area limitations, patient allergies, and exceptional lab results” in addition to reviewing “dosage variables such as ideal weight, serum creatinine, and creatinine clearance.” Sounds like a pharmacist.

Categories: Medication Safety | Tags: CDS, Drug information, EHR, Patient Safety

CPOE – Giving it some thought

Posted on May 25, 2010 by Jerry Fahrni
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Computerized Provider – or Physician if you like – Order Entry (CPOE) is an older technology that has been in the spotlight for the better part of the past year thanks to the American Recovery and Reinvestment Act (ARRA) and key components of meaningful use. Because of the “stimulus” offered by ARRA many hospitals across the United States will be gearing up to implement CPOE, ready or not. Currently less than 20% of the hospitals in the United States are using CPOE, and only a small fraction of those are using it for all orders throughout their facility (AJHP. 2008; 65:2244-64).
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Categories: Medication Safety, Pharmacy Informatics | Tags: BCMA, CPOE

More thoughts on standardization

Posted on May 12, 2010 by Jerry Fahrni
4 Comments

I’ve mentioned this before several times on this blog, but feel like I have to say it yet again; we need to start standardizing certain things about health information technology. The lack of standardization reared its ugly head at me again last week when our Pyxis med stations kept dropping medications off of patient’s active profiles. It appeared to always be the same drug, IV ketorolac. It took me a while to figure out the problem, but it turns out that Pyxis and our pharmacy system don’t agree on certain basic elements of time. Go figure.
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Categories: Database, Medication Safety, Pharmacy Informatics | Tags: Database, Patient Safety, Pyxis, Siemens Pharmacy, Standardization
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