More thoughts on the ASHP national survey results for informatics and pharmacy practice

On Monday I spoke briefly about two articles in AJHP that summarize two recent ASHP surveys. The first covers Pharmaccy Informatics in U.S. Hospitals(1), while the second focuses on pharmacy practice in acute care hospitals(2).

Both surveys contain a wealth of information, and provide a snapshot of what pharmacies in the U.S. are doing. While conducted at different times by different groups, I think it’s more interesting to look at the two surveys together. As I mentioned in my podcast, the adoption of automation and technology goes hand in hand with pharmacy operations. You can no longer have one without the other.
Continue reading More thoughts on the ASHP national survey results for informatics and pharmacy practice Podcast #1: ASHP National Survey Results

Show notes:
Host: Jerry Fahrni

The two surveys discussed in the podcast are below:

Fox, B. I., C. A. Pedersen, and K. F. Gumpper. “ASHP National Survey on Informatics: Assessment of the Adoption and Use of Pharmacy Informatics in U.S. Hospitals–2013.” American Journal of Health-System Pharmacy 72, no. 8 (April 15, 2015): 636–55. doi:10.2146/ajhp140274.

Pedersen, C. A., P. J. Schneider, and D. J. Scheckelhoff. “ASHP National Survey of Pharmacy Practice in Hospital Settings: Dispensing and Administration–2014.” American Journal of Health-System Pharmacy 72, no. 13 (July 1, 2015): 1119–37. doi:10.2146/ajhp150032.

Pre-packaged unit dose from the manufacture or repackaging yourself?

Like it or not barcoding at the point of care has slowly become a standard of practice in acute care pharmacies all over the country. The question is no longer whether or not we should use barcoding technology, but rather how do we use it. And with that comes the need to make sure that all medications dispensed from the pharmacy have a machine readable barcode for nurses to scan at the point of care, i.e. at the patients bedside.

The concept is simple, but causes a lot of headaches inside the pharmacy. While a lot of oral solid medications are available from the manufacture in pre-packaged unit dose packages, some aren’t; sometimes oral solid medications are available in both pre-packaged unit dose as well as bulk.

When oral solid medications are available in both pre-packaged unit dose and bulk containers pharmacies are forced to make a choice. It’s always been a no-brainer for me, purchase medications in manufacturer prepared pre-packaged unit dose packages whenever possible. I look at it as a safety issue. Humans make mistakes, and whenever I can remove humans from something like repackaging oral solids I do it. Manufacturers have been known to make mistakes, but their process is much more rigorous than anything you’ll see in a pharmacy. In addition, manufacturers must adhere to good manufacturing practices (GMP), which are quite extensive.

Recently I’ve come across situations where pharmacies have actively chosen to purchase all oral solid tablets in bulk and repackage the oral solids themselves. I’ve thought about why a pharmacy would make that choice and two things come to mind: cost and efficiency.

Purchasing oral solid medications in bulk is often less expensive. The advantage may be extended if a single location is repackaging for multiple facilities, i.e. centralized distribution. The same goes for efficiency. Repackaging oral solid tablets from bulk bottles may be more efficient during times of high volume, especially if multiple sites are involved. An example of this might be during ADU replenishment for multiple facilities when thousands of tablets may be needed. Picking 2000-3000 tablets from shelving locations may be less efficient than letting a packager run unmanned.

Options for repackaging oral solid medications:

  1. High-speed packagers – I wrote about high-speed packagers here in August of 2010 (Automated unit-dose packagers for acute care pharmacy). Little has changed since then so the information may still be helpful.
  2. Tablettop packagers (semi-automated) – I wrote about tabletop packagers here early this year in January. (Pharmacy tabletop unit-dose packager comparison). You wouldn’t want to use tabletops for large jobs as they require closer monitoring than high-speed packagers.
  3. Manual packaging – There are several out there. One that comes to mind is MTS. There is no way you’d want to use a system like this for any kind of high volume packaging. They work well for niche packaging like chemotherapy, high risk items, etc.

The choice to repackage oral solid medications from bulk or purchase them in pre-packaged unit dose packages from the manufacture is yours. Patient safety, cost, and efficiency should all be considered. In my opinion patient safety should trump cost and efficiency in the thought process, but then again that’s only my opinion.

Requirements for bar code scan verification set too low in meaningful use guidelines

homer-simpson-dohOver the weekend I read an article at HealthBiz Decoded about bar code requirements and meaningful use (MU). I knew that there was some language in Stage 2, but never took the time to read through it carefully. The meaningful use documentation is exactly what you’d expect from years of bureaucrats sitting around trying to generate a document worthy of the governments typical high standard. Yeah, it’s a big ol’ pile of crap. One thing’s for sure, it’s going to create an entire generation of consulting business for a lot of people. I digress.

According to the article, “Hospitals will be required next year to use bar codes to verify 10 percent of medication orders under government health IT rules.”  That number seems pretty low, even for our low reaching federal bureaucracy. And some people have noticed.

The article quotes Mark Neuenschwander, a barcoding evangelist, as saying “We should be striving for a higher percentage because errors can happen in the other 90 percent as easily as they can happen in the 10 percent.” True enough. Anyone out there have a job where 10 percent accuracy, completion or participation is acceptable? If so please give me a jingle if/when you have an opening.

It’s hard for me to imagine what someone was thinking when they pulled 10 percent out of thin air. I’m not naïve enough to think we’ll ever get to 100 percent, but c’mon man, 10 percent! Really? Fifty percent would have been low, but 10 percent is comical.

I think bar coding technology has a place in healthcare. It offers up some real advantages when used appropriately, and I find it disturbing that the MU guidelines find 10 percent scan rates acceptable. That’s some serious weak sauce right there.

Saturday morning coffee [March 30 2013]

MUG_MPSo 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 coffee mug to the right comes straight from Moonstone Pottery in Los Osos, California. It’s a pretty cool mug. It was a gift from my brother, Robert. Thanks bro.

The Croods was #1 at the box office last weekend to the tune of nearly $44 Million. I didn’t see that one coming. I knew that the movie was out, but had no interest in seeing it. My family chose instead to see Olympus Has Fallen. It was terribly predictable and a bit corny, but I liked it. It was full of lots of gratuitous violence and gun play, which makes it my kind of movie. Just for the record, Jack the Giant Slayer has officially flopped at the box office.
Continue reading Saturday morning coffee [March 30 2013]

Cool Pharmacy Technology – RxAdmix

In this issue of The Imaginary Journal of Pharmacy Automation and Technology (IJPAT) we take a look at RxAdmix, a system designed to provide barcode scan verification in the IV room. Now why didn’t I think of that? Great concept when you consider the dangers associated with compounding an intravenous medication incorrectly. Doxorubicin? Daunorubicin? Eh, what’s the difference.
Continue reading Cool Pharmacy Technology – RxAdmix

Bar-code-assisted medication administration in the ED

In reference to the following article:

Including emergency departments in hospitals’ bar-code-assisted medication administration. Am J Health-Syst Pharm. 2012; 69:1018-1019 (don’t bother trying to access the article unless you have a subscription -#fail)

EDs are terrible places for medication administration because the healthcare providers are always in a hurry secondary to the nature of this particular patient care area, i.e. emergencies. All too often medications go unchecked during the medication use process. And to make matters worse, the ED is often times the last place to get BCMA in a planned rollout. It’s also the place where things like BCMA get the most pushback from physicians and nurses.

According to the article “Emergency departments (EDs) are patient care areas that are prone to medication errors. For this reason, we recommend that EDs be considered in any roll-out of BCMA. Studies have shown that the medication administration error rate in EDs is approximately 7%, with 40% of medication errors reaching patients.4,5 The results of these studies suggest that BCMA could reduce ED medication errors, yet this technology is noticeably absent from the ED.” Pretty much what I just said.

In order to benefit from BCMA you have to be willing to deploy it to all areas of the hospital, including the ED. I heard a similar message earlier this year at the unSUMMIT when one of the speakers said that most facilities are far from 100% BCMA compliant because of areas like radiology, infusion centers, EDs, etc.

Makes one wonder how accurate things like the 2011 ASHP National Survey of Pharmacy Practice are. Food for thought.

How Barcode Scanners Work [Infographic]

I’ve been meaning to put this up for a while. I thought the infographic below on How Barcode Scanners Work was awesome! “In our world today, we’re accustomed to seeing barcodes, but most of us don’t have the slightest clue as to how these black and white striped graphics work, or even how they are properly read with a barcode scanner. Better yet, how can barcodes boost efficiency and productivity in small businesses? Not to worry. We’ve outlined a few barcoding basics, including how a barcode scanner works in our latest Infographic.
Continue reading How Barcode Scanners Work [Infographic]

Observational time-motion study comparing trational med administration to BCMA in an ICU [Article]

The article below compares medication administration between paper-based medication administration (PBMA), i.e. the traditional method and bar-code medication administration (BCMA). Unfortunately, as is the case with much of the literature in journals these days, the information is quite old. The data for this observational study was collected in two short spans in 2008 and 2009. The numbers are small, but interesting nonetheless. The results pan out as expected. Items of particular interest were that the nurses in the BCMA groupd spent more time talking to their patients compared to the PBMA groupd, but at the same time spent a heck of a lot more time on drug prep. The first item makes sense, but I’m struggling to understand the drug prep numbers.

The article can be found in the May 2012 issue of Hospital Pharmacy. It is is available for free with registration.
Continue reading Observational time-motion study comparing trational med administration to BCMA in an ICU [Article]