Tag Archives: Pharmacy Practice

Saturday morning coffee [September 13 2014]

“The illiterate of the 21st Century will not be those who cannot read or write, but those who cannot learn, unlearn, and relearn.” -Toffler

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….

MUG_SMC
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Kit Check passes 100 customer mark

Kitcheck.com: “Kit Check™ … today announced that over 100 hospitals are using its cloud-based software solution. The first customer site was installed at the University of Maryland Medical Center in April 2012 and the user base has grown quickly, including more than 50 sites added since January 2014.” – Pretty interesting numbers coming from Kit Check once you get past the marketing jargon. Yeah, I’m calling shenanigans on this statement in the press release: “Kit Check Vice President of Sales Doug Zurawski, Pharm.D., commented, …  “Kit Check already represents the fastest adoption rate in history for hospital pharmacy software and our growth continues to accelerate.” Fastest adoption rate for hospital pharmacy software in history? I’d like to see the fact checking for that statement. I’m going to reserve the right to take that statement with a healthy dose of skepticism. Still, having 100 customers using RFID technology to manage medication trays is pretty impressive.

If you’re more than just a casual reader of this blog then you know that I support RFID technology and believe that it has a niche in pharmacy practice. And one of those niches is medication tray management.

I first mentioned Kit Check back in January 2012. Back then Kit Check was really the only game in town, but times have changed. Not by much, but they’ve changed. Today Kit Check is directly challenged by Intelliguard by MEPS Real-Time, Inc, and to a lesser extent MedKeeper. Each has their potential pros and cons.

Does this mean that RFID is poised to take off in pharmacy practice? Hardly, but it does mean that people are beginning to see the potential benefits of using this type of technology. As long as the companies in this space continue to improve usability I can see potential uptake in the near future.

Color labels for pharmacy – Quick Label Systems

QuickLabel

I was rummaging through my travel bag and found some items that I collected during the ASHP Summer Meeting back in June. Most of the information had to do with IV room systems, tablet identification, and so on. But there was one item that caught my eye that didn’t fit with the rest: color labels.

I’ve written about the use of color on pharmacy labels before. It has its place, but in my opinion the major barriers have been cost and label quality. That’s why I was so interested when I saw the booth from Quick Label Systems at the ASHP Summer Meeting. The labels they had on display were spectacular. It’s difficult to see in my photo, but the image quality and label stock are top notch. The labels are tough –  really tough – resistant to water, and don’t smear. Very nice.

The quality of the label and print gives users the ability to place a crazy array of information on the label, including the ability to embed audio or links to video using bar code technology. It’s pretty cool.

The company isn’t a pharmacy solution in the traditional sense, but do provide OEM services for other companies. In other words, if you have a need for color labels Quick Label Systems will build color label printers with your name on them.

Not every product that leaves the pharmacy needs a color label, but they could certainly be useful in the IV room. Using color to differentiate or highlight something that requires special attention like chemotherapy is always helpful to pharmacy and nursing.

I’ll try to get the rest of my bag’s contents up over the next few days.

Medication Therapy Management as a tool for reduced cost of care and fewer readmissions

A colleague asked me if I had any information on the use of Medication Therapy Management (MTM) as a way to reduce healthcare cost and prevent, or decrease, readmissions.

I’m kind of a digital packrat and I knew that I had some stuff sitting in Evernote, so I spent the better part of a day rummaging through the information I had. The deeper I dug the more I realized that MTM is a no-brainer. There’s enough information out there to convince even the staunchest opposition.

Some thoughts I had as I read through my Evernote notes:

  1. I find it interesting that we’ve coined the phrase Medication Therapy Management (MTM) for something that pharmacists have been doing for decades. I remember interning for a community pharmacy back in the late 90’s. Speaking to the patient about their medication, adherence, compliance, adverse effects, etc was simply part of the job. Have we forgotten about that?
  2. MTM comes in many forms. Positive intervention can be achieved over the phone, via Telepharmacy, face-to-face with a pharmacist or technician, and so on. It is not a one size fits all approach.
  3. Even the simplest interaction between provider and patient can create a positive impact.
  4. MTM should start when a patient is admitted for any condition, continue throughout their hospital stay, and follow the patient out the door to their homes. In other words it should be continuous.
  5. Not everyone will need pharmacist intervention once they leave the hospital. Healthcare systems should first target patients with chronic conditions, problems with cognition, poor history of compliance, or a heavy medication burdens. Like everything else in the world around us, some people will do better with more help while others will prefer less.
  6. mHealth and sensors should be part of MTM. Continuous glucose monitoring, heart monitors, blood pressure sensors, smart bottles, devices to monitor and record inhaler use – classic area for pharmacist intervention, wireless digital scales for weight – think heart failure, and so on . This information should be fed directly into the patients MTM record for review by the pharmacist, physician and nurse.

Below is a summary of the MTM information I sent my colleague.
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Additional thoughts on the use of gravimetrics for I.V. compounding

Scale in PECSeveral months ago I wrote about my thoughts on using gravimetrics for I.V. compounding. At the time I wasn’t convinced of the utility, but my thoughts on the matter have changed. Over the past several months I’ve had the opportunity to dig deeper and mull over my thoughts on the matter.

There was a session at ASHP Midyear back in December titled New and Emerging Strategies for Minimizing Errors in I.V. Preparation: Focus on Safety and Workflow Efficiency. The presentation covered several topics, but one thing that caught my attention was data presented on error rates for the preparation of compounded sterile products (CSPs)1 and the benefits of using gravimetrics in the process. I was skeptical about some of the numbers that were presented. Data is only as good as how it was collected, what it’s compare against, and how it’s presented. One should always question the data, especially when it runs contrary to previously held beliefs.
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New Medscape Pill Identifier Tool [reference]

Medscape Pill IdentifierI received an email this morning from Medscape introducing me to their new Pill Identifier Tool.

The tool is pretty simple to use. When you click on the link above you’ll be taken to the Pill Identifier Tool site where you can begin your search. Any pharmacist, nurse, or physician that’s ever used a reference to identify an oral medication will be familiar with the process.

Across the top of the Pill Identifier you will find several fields to help narrow your search: IMPRINT, SHAPE, COLOR, FORM, SCORING. I’ve always found that if you have the imprint you’re about 80% there.

Clicking on a medication will give you additional information. There’s even an option to view the Drug Monograph.
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New Questions for Pharmacists in the Health Care System [article]

Am J Pharm Educ. 2014;78(2)1: “The pharmacy profession is determining how it will become a vital part of new health care models such as accountable care organizations (ACOs) and patient-centered medical homes (PCMHs). Pharmacists must be prepared to demonstrate their value in these emerging health care models by improving the quality of care, reducing health care costs, and enhancing patient access and satisfaction. The health care decision makers will require demonstration of value, framed in business language, using new measures of outcomes quite different from what have been used in the past for pharmacy services. Colleges and schools of pharmacy should take on the task of developing these new measures demonstrating pharmacist value in collaborative care delivery, and instruct students in how they will need to demonstrate their value in new health care models.

Interesting view from the authors. I’m not opposed to calling for colleges of pharmacy to develop measures to determine the value of pharmacists, but I would caution those developing these measures to learn from others. Physicians defined their measures and outcomes long ago and are paying for it dearly now. Pharmacists should not seek to mimic such a model, i.e. valued on the number of interactions, patients seen, and billable events.

The time for proving that pharmacists can actively participate in patient care is past. The data is there, but the profession continues to think that providing even more data will flip a switch that will instantly make pharmacists a valued member of the healthcare team. That’s not likely to happen, even in the data-driven healthcare environment of today. Pharmacists are viewed quite differently from physicians and other direct patient care providers like nurse practitioners, and rightly so. As pharmacists continue to fight for “provider status” they should consider carefully the end goal of such a fight.

Let’s not forget what pharmacy is all about. Pharmacy is about providing the safest, most effective, cost conscious therapy possible. That doesn’t necessarily equate to “provider status”.  What happens when the primary concern of our profession is no longer pharmaceutical care? Who will provide such expertise when pharmacists no longer concern themselves with such things? I do not recommend living in the past, but I do recommend thinking long and hard about the future of the profession.

Go read the entire article, it’s only a few paragraphs long. I’d love to hear your thoughts.

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  1. Joseph T. DiPiro and Robert E. Davis (2014). New Questions for Pharmacists in the Health Care System. American Journal of Pharmaceutical Education: Volume 78, Issue 2, Article 26. doi: 10.5688/ajpe78226

Is pharmacy informatics defined well enough to be a specialty?

Pharmacy informatics remains in its infancy as a profession. What started out as a job for tech-savvy pharmacists with working knowledge of pharmacy has turned into an ever expanding career field.

I’m looking through the ASHP Summer Meeting Informatics Institute schedule and the topics are varied. I see something on human factors, information management, clinical decision support, and e-prescribing. And that’s only on first glance.

If you look at job descriptions for healthcare systems seeking informatics pharmacists you’ll see everything from involvement in strategic development of services to data entry by monkeys, and everything in between. There’s little consistency in what one facility is looking for versus another. That point alone is telling.

This reminds me of pharmacy practice in acute care facilities 20 years ago. Outside of academic medical centers pharmacists were largely involved in operations, and only slightly involved in other care activities. That’s all changed as pharmacists practice in many different areas today and can specialize in a variety of disciplines, i.e. infectious disease, cardiology, etc.

I think we’re heading in that direction with informatics as well. The field is so vast that being a informatics generalist will soon be impossible because the information will be more than one person can reasonably be expected to handle. The influx of consumer technology and the need for better interoperability between systems will ultimately drive informatics pharmacists to specialize in one, or perhaps a few, specialized areas.

I consider myself an informatics generalist, but wonder how long before I won’t be able to keep up with new developments in the field. I’m already seeing signs of specialties within pharmacy automation and technology, it won’t be long now until we see it in other informatics areas.

Ultimately pharmacy informatics cannot be a specialty as the subject area by definition requires generalist knowledge. Eventually I think we’ll see practice specialties like we do in pharmacy practice today. Until then creating a pharmacy informatics specialty makes little sense.

Proposed USP Chapter <800> for Hazardous Drugs

The rules and regulations swirling around acute care pharmacy clean rooms continues to grow. Recently I became aware of the United States Pharmacopeia and The National Formulary (USP–NF) General Chapter <800> Hazardous Drugs—Handling in Healthcare Settings, or simply USP <800>. I attended a webinar put on by Pharmacy Advisor that specifically addressed USP <797>, but briefly mentioned USP <800>. Then a colleague and friend mentioned it so I decided I better learn a little bit more about the proposed chapter.
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Cool Pharmacy Technology – WillCall Rx from SencorpWhite

I had an interesting call with an account executive from SencorpWhite last week. He and I talked about several things, but one thing I found particularly interesting is something the company is doing in the outpatient pharmacy space with horizontal carousels. Carousels are neat technology for those that have a need for automated storage space, i.e. you’re “space challenged” in your pharmacy. When coupled with bar-code scanning technology carousels are a good way to manage all kinds of inventory in a pharmacy.

The system from SencorpWhite is referred to as WillCall Rx and consists of several components designed to store and retrieve prescription items that have been filled and are ready for patient pickup. I’m familiar with the WillCall Rx system and have had the pleasure of seeing it up close and personal in two large outpatient pharmacies attached to large medical centers. It’s a neat concept.
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