Pharmacy Practice « Jerry Fahrni

Tag Archives: Pharmacy Practice

Medication therapy management at TEDxUniversity [video]

Posted on May 12, 2013 by Jerry Fahrni

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.

Don’t confuse retail pharmacy with pharmacy practice

Posted on April 14, 2013 by Jerry Fahrni

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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

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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
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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.

Saturday morning coffee [March 16 2013]

Posted on March 16, 2013 by Jerry Fahrni

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So 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 was presented to me as a gift from ASHP for winning the 2011 ASHP Summer Meeting Twitter Contest. Not to be confused with the one I put up last August for the 2010 ASHP Midyear Twitter contest. The mug was accompanied by a $50 Best Buy gift card; very nice. The meeting was held in Denver, CO and was the first ASHP Summer Meeting I ever attended. The Summer Meeting is quite a bit different from the Midyear Meeting held in December each year. Midyear is much larger and has a much wider variety of educational sessions. Midyear also has a bigger exhibitor area. With all that said I found the Summer Meeting quite enjoyable as it had several informatics related sessions that I was able to attend. It was the last pharmacy conference that I was able to enjoy as an attendee.
Read more …

#1 thing to consider when buying pharmacy automation and/or technology…

Posted on March 5, 2013 by Jerry Fahrni

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There are a ton of things to consider when you’re thinking about putting new technology in the pharmacy. You have to consider the cost, the impact on your operations, the reputation of the company that you’re buying from, what type of technology you’re going to buy, and so on and so forth ad infinitum.

However, the number one thing you must consider before taking the plunge is whether or not the technology fits your dispensing model. Do you still do a cart fill? Are you completely decentralized? Are you using a just-in-time dispensing model? Will the technology that I’m looking at fit what I hope to accomplish? You need to think about that long and hard before making a decision.

It’s like buying a new vehicle. You certainly don’t buy a Toyota Prius if you need to pull a 24 foot Centurion Enzo SV244 - a really nice boat – to the lake on weekends. No, instead you buy a new Ford Super Duty truck. I know that makes perfect sense to you, yet I hear people frequently say “it doesn’t fit the way we work” when talking about pharmacy automation and technology. When they say that, the first thing that pops into my mind is “then why did you buy it?”. It’s a question that needs serious consideration because some of this stuff is expensive.

I experienced this firsthand in my previous role as an IT pharmacist. We installed new technology that didn’t really fit our distribution model all that well. We tried to cram the technology into an manual process. Didn’t work. I fought it for a few months until the light bulb finally went off. Once we got out act together we redesigned the process around the technology. We took advantage of the automation and filled in the gaps where necessary. It fundamentally changed the way we did things, and in the process improved the overall distribution process.

So before you go and buy a robot, or a carousel, or a high-speed packager, or a compounding machine, make sure you ask yourself how you’re going to use it. This stuff isn’t top secret. Do a quick Google search. Watch some videos. Talk with hospitals that do the same things as you.

In a nutshell do your homework before taking the plunge because once you take the plunge and decide you’ve made a mistake you can only do one of two things: 1) change automation, or 2) change the way you work.

Patient collected information and the role of pharmacists

Posted on February 27, 2013 by Jerry Fahrni

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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

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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.

Interview with Healthcare IS [audio]

Posted on February 12, 2013 by Jerry Fahrni

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I was recently interviewed by Healthcare IS. The audio interview is only about 20 minutes long and covers me answering some general questions about pharmacy informatics, my thoughts on working as an IT pharmacist, etc.

Adding Pharmacists to Primary Care Teams Increases Guideline-Concordant Antiplatelet Use in Patients with Type 2 Diabetes [article]

Posted on February 6, 2013 by Jerry Fahrni

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Here’s an interesting little tid-bit in the January issue of The Annals of Pharmacotherapy. According to the article “adding pharmacists to primary care teams significantly and substantially increased the proportion of type 2 diabetic patients using guideline-concordant antiplatelet therapy“. Good stuff to be sure. Unfortunately the study only looked at the proportion of patients using antiplatelet therapy at 1-year after engaging the pharmacist. It would be interesting to see data around decreased morbidity, hospital readmission rates, etc to go along with the improved guideline-concordance.

Abstract

BACKGROUND: Antiplatelet therapy is recommended as part of a strategy to reduce the risk of cardiovascular events in patients with type 2 diabetes. However, compliance with these guideline-recommended therapies appears to be less than ideal.

OBJECTIVE: To assess the effect of adding pharmacists to primary care teams on initiation of guideline-concordant antiplatelet therapy in type 2 diabetic patients.

METHODS: Prespecified secondary analysis of randomized trial data. In the main study, the pharmacist intervention included a complete medication history, limited physical examination, provision of guideline-concordant recommendations to the physician to optimize drug therapy, and 1-year follow-up. Controls received usual care without pharmacist interactions. Patients with an indication for antiplatelet therapy, but not using an antiplatelet drug at randomization were included in this substudy. The primary outcome was the proportion of patients using an antiplatelet drug at 1 year.

RESULTS: At randomization, 257 of 260 study patients had guideline-concordant indications for antiplatelet therapy, but less than half (121; 47%) were using an antiplatelet drug. Overall, 136 patients met inclusion criteria for the substudy (71 intervention and 65 controls): 60% were women, with mean (SD) age 58.0 (11.9) years, diabetes duration 5.3 (6.0) years, and hemoglobin A_1c 7.6% (1.5). Sixteen (12%) had established cardiovascular disease at enrollment. At 1 year, 43 (61%) intervention patients and 15 (23%) controls were using an antiplatelet drug (38% absolute difference; number needed to treat, 3; relative increase, 2.6; 95% CI 1.5-4.7; p < 0.001). Of these 58 patients, 52 (90%) were using aspirin 81 mg daily.

CONCLUSIONS: Adding pharmacists to primary care teams significantly and substantially increased the proportion of type 2 diabetic patients using guideline-concordant antiplatelet therapy.