Pharmacy Practice « Jerry Fahrni

Category Archives: Pharmacy Practice

Purdue University develops tablet-based pharmacy tool for catching medication side effects

Posted on June 12, 2013 by Jerry Fahrni

Tablets are changing the way healthcare professionals practice medicine.

Purdue.edu: “Matthew Murawski, a Purdue University associate professor of pharmacy administration, created a new tool that presents patients with a five-question checklist that catches up to 60 percent of all known medication side effects….”This tool makes the few minutes available for counseling much more rewarding. The checklist results allow the pharmacist to immediately see side effects the patient is experiencing and target their time to solving these problems and improving the patient’s quality of life.” …Murawski’s method, named Pharmaceutical Therapy-Related Quality of Life or PTRQoL, began as paper checklists that took up multiple file folders behind a pharmacist’s desk.”

Purdue University does some cool stuff around the practice of pharmacy. The only thing that makes me cringe is the line “patent pending” (approx. 1:05 into the video). Nothing that is developed utilizing University resources should ever be allowed to be patented. It should all be open source.

Thoughts on the ASHP Summer Meeting (#ashpsm)

Posted on June 6, 2013 by Jerry Fahrni

1 Comment

I’ve just returned from the ASHP Summer Meeting in Minneapolis, MN. I was there for work, but managed to squeeze in some sessions; just like a real pharmacist.

For those of you that don’t know, the ASHP Summer Meeting is small, really small. It pales in comparison to the ASHP Midyear Meeting that’s held each year in December. Being small doesn’t make it bad, it just makes it small. The sessions are smaller and less grand, and the exhibitor area is quite a bit smaller than Midyear as well.

Medication therapy management at TEDxUniversity [video]

Posted on May 12, 2013 by Jerry Fahrni

No Comments

Thanks to Megan Hartranft (@MeganPharmD) and John Poikonen (@poikonen) for tweeting this. It’s nothing earth shattering, but it sums up why pharmacists should be more involved. Tim Ulbrich does a really nice job.

Pharmacy schools should show this short video to all their pharmacy students before turning them loose on the world. I talked about some of this in my presentation at the HIMSS Southern California Annual Clinical Informatics Summit a couple of weeks ago.

There was a time when I thought that the best place to engage patients was in the hospital, but I’m starting to rethink that position. If you think about it, engaging patients in the hospital is a bit of a reactive approach. We need to engage patients before they’re hospitalized to get the most bang for our buck.

Info packets instead of a pharmacist used in attempt to improve medication adherence

Posted on May 9, 2013 by Jerry Fahrni

No Comments

I came across an article today in The Baltimore Sun that caught my attention.

According to the article: “In a test of services geared toward making sure patients took their prescribed medications after leaving the emergency room, none made a difference, a large new study suggests.

Based on the experiment involving nearly 4,000 ER patients, researchers found that information packets, personal assistance and even access to an on-call medical librarian to answer questions about the drugs did not lead patients to fill more prescriptions or to take them as directed when they left the hospital.”

The best line from the article has to be that patients were given “access to an on-call medical librarian to answer questions about the drugs [they were prescribed]” This has to get the head-scratcher of the year award. The lunacy of healthcare never ceases to amaze me. Why, oh why would you give patients access to a medical librarian to answer drug questions. I have great respect for medical librarians, but that’s not their domain.

And as a surprise to no one, “One week after ER discharge, 88 percent of patients had filled their prescription, according to pharmacy records, and in a phone interview 48 percent reported taking the medication as prescribed. Those percentages did not differ between the participating groups.”

No kidding. Medication adherence is an incredibly complex problem with many different reasons why patients choose not to get their prescriptions filled or fail to take them consistently and accurately.

Depending on the study you read, medication adherence costs the United States anywhere from $100 billion to $290 billion annually, including increased morbidity, lost time from work, readmissions, etc. Pharmacists have been shown to help. Handing out pamphlets has not.

Honestly, I’m surprised that the Annals of Emergency Medicine would publish such crap. My cats leave equivalent work in the yard all the time, but at least they try to cover it up.

The article – Does Providing Prescription Information or Services Improve Medication Adherence Among Patients Discharged From the Emergency Department? A Randomized Controlled Trial – can be found here.

Morons.

Smartphone medication adherence apps [Article]

Posted on May 5, 2013 by Jerry Fahrni

1 Comment

Not sure how I missed this one, but there’s an article in the March-April 2013 issue of the Journal of the American Pharmacist Association that covers smartphone applications for medication adherence.

Smartphone medication adherence apps: Potential benefits to patients and providers (J Am Pharm Assoc. 2013;53:172-181)

From the abstract: “160 adherence apps were identified and ranked. These apps were most prevalent for the Android OS. Adherence apps with advanced functionality were more prevalent on the Apple iPhone OS. Among all apps, MyMedSchedule, MyMeds, and RxmindMe rated the highest because of their basic medication reminder features coupled with their enhanced levels of functionality.”

There’s a lot of good information in the article, especially the bibliography. To top it off, the article is available in its entirety for free so go get it. Actually, the entire March-April issue is worth reading.

Evolution of [Pharmacy] Practice in an Age of Information [Presentation]

Posted on May 4, 2013 by Jerry Fahrni

1 Comment

Yesterday I was at Children’s Hospital of Orange County in Orange, CA. for the HIMSS Southern California Chapter 5th Annual Clinical Informatics Summit: Adventures in Clinical Informatics. I was there to give a presentation about pharmacy. It’s the first public presentation I’ve given since retiring from the presentation game just over two years ago. Now that it’s over I’m heading back into presenter retirement.

The presentation in its entirety has been uploaded to Slideshare and is embedded below. Some of the slides didn’t show up at the time of upload. I tried a couple of different things to get them to show up, but at last view they still weren’t there.

Evolution of practice in an age of information from Jerry Fahrni

Don’t confuse retail pharmacy with pharmacy practice

Posted on April 14, 2013 by Jerry Fahrni

14 Comments

I was at a volleyball tournament in Forestville, California yesterday. It’s a beautiful place located in Sonoma County above Santa Rosa. Unfortunately it’s also a 4G/3G black hole. I had virtually no connectivity most of the day, but as luck would have it I caught a Tweet from Bob Diamond that led me to an article in The Wall Street Journal, 10 Things Drugstores Won’t Tell You. The article had some interesting things to say, but was terribly biased and incomplete. Was the information accurate? Sure, to a point.

10 Things Drugstores Won’t Tell You – Tough article in WSJ ow.ly/k1TJR #pharmacy #medicine #healthcare @pharmacyupdates

— Bob Diamond R.Ph (@pharmacistbob) April 13, 2013

Clinical Dilemmas and a Review of Strategies to Manage Drug Shortages [article]

Posted on April 3, 2013 by Jerry Fahrni

No Comments

Here’s an interesting article in the Journal of Pharmacy Practice. The article, Clinical Dilemmas and a Review of Strategies to Manage Drug Shortages appears online ahead of print (doi: 10.1177/0897190013482332). Unfortunately you’ll hit a paywall, so if you don’t have a subscription all you’ll get is the abstract.

That’s unfortunate because according to the article “The expanded phased approach outlined here [in the article] provides a consistent, systematic approach for the management of drug shortages“. You would think they’d want everyone to know about the expanded phased approach due to the “health care crisis” created by drug shortages. Just sayin’.

Abstract
———————————————-
Objective: The objectives of this article are to review the clinical implications of drug shortages highlighting patient safety, sedation, and oncology and introduce an expanded phase approach for the management of drug shortages. Data Sources: Literature retrieval was accessed through a PubMed search of English-language sources from January 1990 through April 2012 using the medical subject heading pharmaceutical preparations/supply and distribution and the general search term drug shortages. Study Selection and Data Extraction: All original prospective and retrospective studies, peer-reviewed guidelines, consensus statements, and review articles were evaluated for inclusion. Relevance was determined considering the therapeutic class, focus on drug shortages, and manuscript type. Data Synthesis: The increased number of drug shortages has created significant challenges for health care providers. Two particularly vulnerable populations are critically ill and oncology patients. A lack of therapeutic alternatives in critically ill patients may impact patient safety as well as treatment outcomes. Similarly, a chemotherapy agent in short supply may contribute to adverse outcomes in oncology patients. Conclusions: The mounting number of drug shortages has created a health care crisis, requiring changes in management strategies as well as clinical practice. The expanded phased approach outlined here provides a consistent, systematic approach for the management of drug shortages.

Patient collected information and the role of pharmacists

Posted on February 27, 2013 by Jerry Fahrni

3 Comments

I had an interesting phone conversation this morning with Kevin Sneed, Pharm.D.(@DeanSneed), Dean at the University of South Florida College of Pharmacy (USF COP). I’ve been trying to connect with Dr. Sneed for a while now, but as you can imagine his schedule is pretty full. Fortunately for me I was able to grab about 30 minutes of his time this morning. And what a great 30 minutes it was. I was so impressed with what he had to say that I’m planning to visit USF COP sometime in the next couple of months to continue the conversation and get a first hand look at what’s going on there.

While I could expound on our conversation for several pages, one comment that Dr. Sneed made struck me as so profound that I thought I would quickly share it.

During the conversation we started talking about data, and where it’s coming from. Pharmacy is a data driven science, but never has the data come from so many directions. Dr. Sneed commented that patients are taking control of information these days, and not only are they more informed, but they are generating much of the information that will be used in their care. Patients are becoming connected more and more. This is especially true with the advent of mobile technologies that wirelessly transmit tons of data for everything from exercise regimens, to weight, glucose readings, heart rate measurements, and so on. Dr. Sneed sees a future where patients will present this information not only to physicians, but other healthcare professionals such as pharmacists as well; it will be used as currency to start conversations and facilitate care. I’ve heard people in healthcare refer to data as currency before, but I never really made the connection until now.

It’s clear that we’re in a new age of heatlchare, and pharmacists need to be prepared to collect this information and utilize it to provide better pharmaceutical care. This may sound superficial on the surface, but it is a very important point. Think of a time, not so far in the future, when pharmacists will have a lot more information about patients at their fingertips. This will likely occur across all pharmacy environments, i.e. outpatient, long term care, acute care, etc. This information will give pharmacists an ever increasing role in direct patient care.

Something to think about as pharmacists prepare for a future healthcare model that is rich in information provided by their patients. Exciting opportunities lie ahead if we’re prepared to accept them.

Who should drive the selection of pharmacy automation and technology?

Posted on February 16, 2013 by Jerry Fahrni

7 Comments

Who should be the driving force behind the selection of new automation and technology in a hospital pharmacy? It’s a simple question really, and in my mind there’s only one clear answer: pharmacy should drive the selection of their own automation and technology. That makes sense, right? Well it certainly does to me.

However, lately I’ve seen a disturbing trend when talking with hospital pharmacies about their selection process. It appears that the IT department – you know, those guys that configure computers and keep your network and hospital servers humming along – has been given a lot of authority in the selection process. Call me crazy, but that seems a little strange to me.

I’ve always thought of IT as a service department, someone to help you accomplish your goal when it involves technology. As an IT pharmacist it was my job to look at pharmacy automation and technology, evaluate it, weigh the pros and cons, and make a decision based on what was best for the goals of the pharmacy. Once that was done I would get IT involved in the process to make sure we had everything we needed from not only the vendor, but our own hospital IT department as well. If there were gaps we would work together to flesh them out.

What happens if the IT department is given the leeway to make a decision for the pharmacy on which automation and/or technology they should use? They might make the “right decision”, but if they did it would be the result of sheer dumb luck. The selection process should be one that looks to find the best fit for the pharmacy, one that fits into the pharmacy’s distribution model, one that lines up with existing technology, one that takes future pharmacy plans into consideration, one that will help drive pharmacists out of the pharmacy toward more clinical activities, one that acknowledges the strengths and weaknesses of the vendor in terms of functionality, usability and support, and so on. The decision should not be based on who uses the best security protocol, or who prefers Dell Servers over HP Severs, or whether or not the vendor needs network access for support or not, and so on and so forth.

I truly feel sorry for healthcare systems that ignore their pharmacy personnel when thinking about purchasing new automation and technology for pharmacy operations. In my opinion it’s a recipe for disaster. I certainly wouldn’t want to work in a pharmacy where the tools I used were selected by someone who didn’t even know what I was working on. The next time you have the oil changed in your car, ask the mechanic if he would let the person that installed their computers pick out his tools. I bet you’ll get a similar response to mine, although the language may be a bit more colorful. Better yet, ask a software engineer if he’d let a pharmacist pick out the hardware and software necessary to do his job. It’s a safe bet that he’d look at you like you’d lost your mind.