Tag Archives: Pharmacy Practice

Cool Pharmacy Technology – Aesynt REINVENT [it’s about the data]

Data surrounds us. We’re deluged by it in every facet of our lives, from the bank statements we receive in our personal life to the mountains of data collected in healthcare. Regardless of the data collected, there are basically three things that can be done with the information. It can be ignored, archived, or used. Unfortunately only one of those three things is truly meaningful, using it.

Many, especially in pharmacy, chose to ignore or archive data rather than use it. That’s not because the information isn’t valuable, but rather because they are overwhelmed with the amount of information they receive and simply have no idea what to do with it. Throw in the fact that the more data we collect, the more useful it becomes, and things get weird. Seems counterintuitive, but data collected from a single source, say one pharmacy i.v. room, offers little value.

Single source data creates several problems, such as potential bias, the inability to find trends that may be available in larger data sets, and failure to create usable comparisons to others that may offer insight into improved operations. Only when data is collected from several different sources does one truly begin to understand its value.
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Aethon launches TraySafe at #ASHPSM15 in Denver

I’ve been at the ASHP Summer Meeting in Denver this week roaming the exhibit hall looking for interesting new products. One product that caught my attention was TraySafe by Aethon.

TraySafe is a medication tray management system. There are several such systems currently on the market, but what makes TraySafe different is its approach to the replenishment process. The system utilizes a combination of photo recognition and barcode scanning to analyze tray content and notify the user of items that are missing, in the wrong location, or about to expire.

TraySafe1
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Pharmacy – entrenched in outdated dogma

Dogma: belief or set of beliefs that is accepted by the members of a group without being questioned or doubted (Merriam-Webster)

I have opinions, lots of opinions. And like most, I believe my opinions are valid; it’s human nature. It’s not uncommon for me to find people within a group that agree and disagree with my opinions. However, once in a while I come across an entire group of people that stand in disagreement with my thoughts. That’s not crazy to imagine, but when that happens I’m forced to re-evaluate. Let’s face it, if everyone thinks I’m wrong, it’s possible that I am.

Such is the case with my thoughts on the use of technology and personnel in the i.v. room, which are on record at this site and are quite transparent. In a nutshell I believe that:
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“Improving Safety and Efficiency in the IV Room” : thoughts on the ASHP webinar

I previously wrote about a live webinar put on by ASHP – Improving Safety and Efficiency in the IV Room: Key Features of Automated Workflow Systems – on Wednesday, May 20 2015. The webinar was made up of three separate, 20 minute presentations:

  • Medication Error Reduction Strategy Using Dispense Preparation and Dispense Check by Tom Lausten, RPh, Director of Pharmacy at Children’s Hospital of Wisconsin.
  • IV Workflow Systems: Barcode Plus Volumetric Verification by Steve Speth, RPh, Pharmacy Operations Manager at IU Bloomington.
  • Automated i.v. Workflow Systems and Technologies by Caryn Bellisle, RPh, Director of Pharmacy Regulatory Compliance at Brigham and Women’s Hospital.

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Upcoming ASHP Webinar: Improving Safety and Efficiency in the IV Room

This caught my attention. ASHP is holding a live webinar – Improving Safety and Efficiency in the IV Room: Key Features of Automated Workflow Systems – on Wednesday, May 20 2015 at 2:00 PM ET.

According to the webinar site “Technology for IV rooms can be used to streamline work processes and support staff.  However, despite the advancements in technology there are still significant challenges in the compounding of sterile products. This webinar will take a look at IV room technologies and how it has improved IV room operations and overall safety for patients.  The speakers will also review the cost benefits, the key safety components including barcode scanning, imaging and gravimetric technology, and the best practices related to implementation and maintenance of these automated processes.

Objectives listed include:

  • Describe the most common IV Compounding Safety technologies available in workflow programs today
  • Describe and contrast the types of errors that the workflow technologies may affect
  • List key benefits of workflow systems beyond the reduction of errors
  • List and describe key considerations when choosing an IV workflow system

I look forward to attending as this is an area of great interest for me. I will be looking for depth of information presented in an unbiased manner. Not sure how deep they can go in an hour, but should be worthwhile nonetheless.

You can register for the webinar here, or by following the link above.

ASHP updates chemotherapy guidelines

ASHP Guidelines for Chemotherapy

It seems as though everyone has chemotherapy on the brain. The National Institute for Occupational Safety and Health (NIOSH) is in the process of updating their Alert on Preventing Occupational Exposures to Antineoplastic and Other Hazardous Drugs in Health Care Settings. NIOSH already released a new list of hazardous drugs late last year. The U.S. Pharmacopeial Convention (USP) is busy finalizing General Chapter <800> Hazardous Drugs – Handling in Healthcare Settings. And now, ASHP has published updated chemotherapy guidelines.(1)
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More thoughts on USP <797> and pharmacy IV rooms [comment from reader]

A friend and colleague, Ray Vrabel, left a comment on my post from April 20th. I thought what Ray had to say was too good not to post. He raises some good points, which are worth more discussion.

Ray is a sharp guy, and he and I have had some good conversations over the past couple of years. He’s passionate about patient safety and pharmacy practice. While I don’t always agree with everything that Ray has to say, I definitely appreciate his thoughts and opinions.

Make sure to read more of Ray’s thoughts here.

Jerry,

Your post has got me wondering about a number of things: Area 51, The Kennedy Assassination, Obama’s birth certificate, and now USP797.

You raise the question which I have always wondered about: What was the problem that USP797 was attempting to solve? Was there documentation of significant problems associated with pharmacy-prepared IV admixtures by pharmacies who were following the ASHP Guidelines in place before USP797? Did anyone conduct a multi-hospital study to determine if hospitals following pre-USP797 ASHP Guidelines had any clinical problems associated with pharmacy IV admixtures? In other words, what is the science that drove the USP797 standards?

We have effectively turned our pharmacy IV Rooms into GMP-like sterile manufacturing facilities. So now, if properly followed, we have hospital pharmacies preparing a very high quality product from a sterility standpoint. That’s a good thing, but we also have a number of unintended consequences:

(1) Most IV admixtures are now prepared by pharmacy technicians, but they are no longer being directly supervised by pharmacists because of the onerous garbing requirements, making it inconvenient for the pharmacist to move into and out of the IV room.

(2) While there is now a requirement that every pharmacy must follow UPS797 standards, we do not have a technician licensure/certification requirement for all technicians in all states.

(3) While USP797 has required the use of all types of environmental, operational, and testing products, there is no requirement for pharmacies to use barcode checking of the IV admixture ingredients (i.e., Label, bag, and additives). Why do we have excellent sterility requirements with no requirement for accuracy of IV additive preparation?

What’s wrong with this picture? We now have sterile IV admixtures, but we don’t have any standards to make sure that the IV admixture is made correctly (i.e., correct ingredients). I feel that barcode scanning during medication preparation (BCMP) should be the minimum standard for ALL IV admixtures in ALL pharmacies. For more on this, please see my LinkedIn post: https://www.linkedin.com/pulse/why-hospital-gift-shops-more-important-than-pharmacy-iv-vrabel.

What practice area benefits most from increased sterile compounding regulation?

I recently sat through a webinar that was recorded during a live symposium at ASHP Midyear in Anaheim on December 8, 2014. The symposium was entitled “Understanding the New Federal Framework for Oversight of Sterile Compounding” (1) and consisted of three separate presentations, one of which was given by Eric Kastango. (2)
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Cool Pharmacy Technology – Kiro Oncology System

I’ve recently had conversations with several companies outside the U.S. developing robotic technology for the i.v. room. One of those systems is the Kiro Oncology System. Check the video below.

A couple of things worth noting:

  • The system uses dual robotic arms during the compounding process. This is something that is important for the next generation of i.v. room robots. The current crop of i.v. room robots here in the U.S. use a single arm. Think about the inefficiency of one-armed sterile compounding.
  • The Kiro Oncology System is self-cleaning. This is a concept that appears to be more popular “in Europe” than it is here in the U.S. Kiro Oncology isn’t the first overseas group I’ve dealt with that is pushing the idea of self-cleaning. None of the U.S. vendors have ever mentioned it.

Managing medication trays in acute care pharmacy

Medication trays – a.k.a. med trays, code trays/kits/boxes/bags, transport trays/kits/boxes/bags, intubation kits, C-section trays, anesthesia trays, and so on ad infinitum – are common in acute care pharmacies.  I’ve seen them in every variation you can imagine in every pharmacy I’ve ever been in.

Depending on the situation, med trays can contain a large number of injectable medications. For example: code trays may contain several different neuromuscular blockers like vecuronium, rocuronium, succinylcholine; pressors like epinephrine, norepinephrine, phenylephrine;  other code drugs like atropine, vasopressin; reversal agents like naloxone and neostigmine; antibiotics, etc, while a C-section tray may contain local anesthetics in various shapes and sizes (lidocaine with or without EPI, SDV or MDV, bupivacaine of various concentrations, etc). The list goes on. It’s pretty crazy.

Anesthesia_Tray
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