Jerry Fahrni

Bar code medication administration (BCMA) is nothing new, but remains a hot topic in healthcare nonetheless. Another topic that has generated significant interest in healthcare over the past couple of years is the use of smart pumps, which I have posted on before. Unfortunately for most hospitals the two remain independent of one another with no appreciable integration. The integration of smart pumps with BCMA was one topic of discussion at this years ASHP midyear. I attended a couple of presentations from healthcare systems that had successfully integrated information from their pharmacy information system (PhIS) directly into their smart pumps for use with their BCMA system. Like many other ideas presented at large conferences, the situation is the exception rather than the rule.
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Medication reconciliation is defined by JCAHO as “the process of comparing a patient’s medication orders to all of the medications that the patient has been taking. This reconciliation is done to avoid medication errors such as omissions, duplications, dosing errors, or drug interactions.” The process should be fairly straight forward, but it is actually very difficult and time consuming.
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I read Warner Crocker’s musings at GottaBeMobile as well as his Tweets via the @LPH/tablet-pc-enthusiasts list on Twitter. Warner also has a second blog called Life On the Wicked Stage: Act 2, which I do not read with any regularity. I was, however, driven toward his personal blog secondary to a Twitter post. The post, titled Rush and My Mom: Two Different Care Experiences, talks a little about his experiences with his mothers medical care. She is apparently very ill with lung cancer. I sympathize with Warner as my mother-in-law, Mary Lou, succumbed to lung cancer in December of 2008. I also understand much of what he is talking about as my wife and I experienced similar problems during Mary Lou’s chemotherapy, pain management and surgeries.
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Today was a good day for informatics at ASHP Midyear.

Pharmacy 2.0: How the Web is Changing How We Practice
This was a great session moderated by John Poikonen (@poikonen), PharmD or RxInformatics.com. John defined Pharmacy 2.0 as the combination of ASHP’s practice model, participatory medicine, health reform, and self-reform, i.e. changing the way you work. In an interesting move Poikonen asked the audience how many of them were familiar with the term “hashtag” and mentioned the use of #Midyear2009 as a way to follow the meeting on Twitter. Unfortunately very few pharmacists raised their hand to acknowledge the term. I wish we had a way to quantify the number, but it was only 10-20 in a crowd of a couple hundred. It’s obvious that the crowd had an interest in the subject by their presence, but as I already suspected pharmacy has a long way to go before we can be considered tech savvy.

Todd Eury (@toddeury) of Pharmacy Technology Resources and Pharmacy Web 2.0 presented on “Healthcare System Communications Evolution: Pharmacy and Web 2.0”. In his presentation he introduced many of the most commonly used social media available today; specifically LinkedIn, Twitter and Facebook. He did an excellent job of defining their role in pharmacy practice and communicating not only their benefits, but pitfalls as well. One thing of particular interest in Eury’s presentation was the need to monitor your online reputation and occasionally “Google yourself”. Try it; you’ll be surprised at what you find.

Kevin Clauson (@kevinclauson), PharmD of Nova Southeastern University College of Pharmacy presented “A Pharmacist’s Web 2.0 Toolkit for Information Management.” He covered the use of RSS Readers, like Google Reader, PeRSSonalized, and Clinical Reader, as well as Twitter and Evernote as a way for pharmacists to keep up with the ever changing world of information that we have to digest and assimilate. I consider myself pretty well versed in the ways of the web, but Kevin offered up some great pearls of wisdom that I can immediately put into practice.

The final segment of the Pharmacy 2.0 session was a video presentation by Dr. Daniel Sands (@drdannysands) in which he spoke about physician’s use of social media and the web to communicate with his patients. He also covered ways that patients can get involved in their own healthcare through the use of online societies specific to their condition. Dr. Sands spent several minutes in the video interviewing physicians in his own practice about their views on social media and its impact on their relationship with patients. Not surprising some physicians spoke positively about the technology, while others were not so flattering.

Pharmacy Informatics Education Networking Session
This session offered up some of the most interactive discussion that I’ve been involved with during my time here at Midyear. The discussion centered on what informatics education standards should be for pharmacy students and how that should translate into a “qualified informatics pharmacist”. It was interesting to see the difference in opinions from pharmacist to pharmacist. While I won’t go into exactly what was covered I think everyone in that room needs to remember that pharmacists are highly educated clinicians that deserve to practice informatics at that same level. A <insert title here; clinical informaticist, Informatics pharmacist, pharmacy informaticist, clinical informatics pharmacist, medication management informaticist> should not be the guy sitting in a cubicle writing reports day in and day out, or the guy that has to edit each line item in the pharmacy information system because “G” should be “GM”. The <insert title here> should be the individual involved in making sure that systems are designed to include pharmacy workflow, that the reports being written provide the necessary information to be clinically relavent, that current clinical standards are adhered to during implementation of new systems, be the representative at the table during discussions of integration and interoperability of hospital systems, etc. Pharmacy informatics is a young discipline and a step in the wrong direction can harm the profession for years to come.

Informatics Bytes 2009: Pearls of Informatics
This session, which is still going on, has a little bit of everything when it comes to pharmacy informatics and patient safety. They announced that the session would be recorded. Maybe they’ll even create a podcast out of it; one can only hope.

The first, and most interesting, session I attended today was “Integrating Technology to Improve Medication-Use Patient Safety”. The session was sponsored by Hospira and consisted of three separate speakers covering areas of the medication–use process where breakdowns typically occur. The focus was on closed-loop medication administration. I’m sure there are different opinions on what closed-loop medication administration is, but for our purposes it consists of orders from the time written until the medication is administered to the patient. Many technologies were discussed, including computerized provider order entry (CPOE), bar code medication administration (BCMA), intelligent infusion devices (IIDs), and electronic medication records (EMRs) among others.
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As usual there were a lot of things that happened during the week, and not all of it was pharmacy or technology related. Here’s a quick look at some of the stuff I found interesting.
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Entering and making pediatric drips for pharmacists working in an adult hospital can be a real sphincter tightener. Pharmacists that aren’t accustomed to working with pediatric patients feel a little bit uneasy when an order shows up for a customized dopamine, dobutamine, etc. I remember working in a pediatric facility where we did this kind of thing all the time and no one gave it a second thought. We used a combination of two standardized concentrations, hi and low, for each commonly ordered drip. For code blue situations we often used the “Rule of 6’s”, which is now discouraged by the Joint Commission.
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Researchers from the Technische Universität München (TUM) have developed a small microchip that can automate the process of testing the activity of cancer drugs against a patient’s tumor cells.

The chip is just a few millimeters in size, but packed with sensors. Here, a ceramic version of the chip is shown.

The microsensors on the chip record, among other things, changes in the acid content of the medium and the cells’ oxygen consumption; photographs of the process are also taken by a microscope fitted underneath the microtitre plate. All of the data merge in a computer that is connected to the system, and which provides an overview of the metabolic activity of the tumor cells and their vitality.

The robots and microtitre plates are kept in a climatic chamber, which, through precisely regulated temperature and humidity, provides an environment similar to that of the human body, and also protects the tumor cells against external influences that can falsify the test results.

After the tumor cells have been able to divide undisturbed for a few hours, the robot applies an anti-cancer substance. If their metabolic activity declines over the next day or two, the active substance was able to kill the tumor cells and the drug is effective. Using the microchips, twenty-four active substances or combinations of active substances can be tested simultaneously in this way.

The reason that such technology is so important is obvious; treatment with chemotherapy is dangerous and unpleasant for patients. The ability to automate the identification of an ideal chemotherapy regimen not only decreases the patient’s exposure to unnecessary chemotherapy, but speeds up the entire process as well.

The Annals of Pharmacotherpy (Vol. 43, No. 11, pp. 1912-1913): “Approximately 80% of pharmacists use the Internet to obtain drug information.1 Wikipedia, often found at the top of Internet search results, is a free-access, collaborative, online encyclopedia that can be edited by anyone.2 Incidents of vandalism have occurred, since the site allows anyone to contribute. For example, an incident occurred in which a fake biography was created as a joke to implicate prominent writer and journalist John Seigenthaler for the assassination of John F Kennedy. It took about 4 months until the fake biography was detected and deleted by Wikipedia.3 Although Wikipedia does have an internal quality review, the ability of internal editors to find and correct erroneous information may not be timely. As reported by Clauson et al.,4 the information found on Wikipedia may not be complete and accurate, especially in regard to drug information. Published data regarding pharmacists’ use of Wikipedia to obtain drug information is lacking. Therefore, the objective of this study was to measure pharmacists’ use and perception of Wikipedia for obtaining drug information.” – This letter to the editor discusses the results of a questionnaire given to pharmacists regarding the use of Wikipedia for drug information. I was disturbed to read that 28% of respondents reported using Wikipedia for drug information. Strange that it doesn’t appear on any of my drug information resources lists, and never will. I expect better from pharmacists.

As usual there were a lot of things that happened during the week, and not all of it was pharmacy or technology related. Here’s a quick look at some of the stuff I found interesting.
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