Tag Archives: Pharmacy Practice

#ASHP Midyear final thoughts

I concluded my time at ASHP Midyear in Anaheim on Tuesday evening. Here are my parting thoughts.

  • The show felt more lively this year than the past couple. It’s hard to explain, but it felt like people were interested in everything around them; a good sign.
  • There was an infusion of new products in the exhibit hall. The “normal” stuff was there, but it is clear that the vendors are once again ramping up. The introduction of meaningful use several years ago put a stranglehold on pharmacy budgets and projects. Everyone put all their eggs in one basket, i.e. all resources redirected to a single goal. During that time hospital pharmacies entered a black hole in regards to the implementation of new technology. It appears that equilibrium has been restored.
  • The “Pharmacy of the Future” Pavilion was anything but the pharmacy of the future. It was nothing more than a giant advertisement for the vendors. Nothing stood out as futuristic.
  • There was virtually no discussion/exhibits for track and trace. Given the state of H.R. 3204, the Drug Quality and Security Act (DQSA), this is going to be a big deal over the next several years. I expected to see more. Then again, the exhibitors have to reserve their booths a year in advance. Hard to plan around that.
  • Didn’t see much to do with Telepharmacy. In fact, I can only think of a single exhibit and that was an outpatient system.
  • The acquisition of CareFusion by BD is interesting for several reasons, but I wonder how the two companies will handle their i.v. workflow management systems. CareFusion has PyxisPrep and BD has BD Cato. Given the limitations of PyxisPrep in its current state it would be hard for me to imagine them not going with BD Cato as their flagship system in the i.v. room. Only time will tell.
  • The acquisition of CareFusion wasn’t the only big move that BD made this year. Apparently BD has partnered with Aethon for medication tracking outside the pharmacy.
  • Envision’s exit from the i.v. workflow management space should be interesting. With their intellectual property for image capture/remote verification going to BD, I wonder what will become of the rest of the product, i.e. the software. The product had a solid foundation and some nice functionality. Hmm, gives me a couple of ideas.
  • APOTECA was conspicuously absent from the exhibitor floor. I found that odd considering that they are one of only two manufacturers of hazardous compounding robots in the U.S. The company also introduced a semi-automated i.v. workflow management system, APOTECAps earlier this year. I fully expected to see the products on display at ASHP Midyear. Not the case.
  • Omnicell entered into an agreement with Baxter to both sell and integrate with DoseEdge. This should allow Omnicell to track CSPs prepared with DoseEdge throughout their suite of products. Everyone is scrambling to get into the i.v. room.
  • As mentioned previously, Closed System Transfer Devices (CSTDs) seemed to be popular among the exhibitors. At least three separate companies – EQUASHIELD, BD, ICU Medical – were showing off their products. I’m not surprised with USP <800> looming in the not too distant future.
  • RFID seems to finally be picking up some steam in pharmacy practice. Several companies were displaying RFID solutions. Several others announced partnerships with those same companies. The most popular areas for RFID appear to be refrigerated inventory management, anesthesia, and medication trays/carts.

More from #ASHP Midyear

Yesterday was more of the same, i.e. I spent several hours in the exhibit hall yesterday trying to make my way through my “game plan”. And again I failed to complete my mission. I spent a lot of time speaking to various people about some of the things I saw on Monday.

Some of my stops and thoughts from yesterday:
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CareFusion announces partnership with Kit Check at #ASHP Midyear

Last night I attended the first ever CareFusion Insider Event held at ASHP Midyear. The event was designed to spotlight CareFusion and their product line. Some new things were announced like the introduction of a Pyxis Mini and a new focus for the Rowa Dose System. CareFusion has had the Rowa Dose System for a while, but it was initially targeted at markets outside the U.S.

Something I hadn’t expected was an announced partnership with Kit Check. I have written about Kit Check and Anesthesia Check before.

According to the press releasetoday announced the companies will partner by connecting their hardware, software and RFID solutions to offer improved efficiency and accuracy in medication handling from pharmacy dispensing to OR point of use”.

It’s unclear how deep the integration will run, but it’s clear after last night’s event that CareFusion is pushing a more integrated approach across the entire healthcare continuum.

I’ll be stopping by both the Kit Check and CareFusion booths over the next couple of days to find out more.

Cool Pharmacy Technology – Eyecon Visual Counting System

It’s hard to imagine that pharmacies still manually count medications and pour them into bottle for distribution to patients, but it goes on all the time. Even large pharmacies that have robotic dispensing systems still have to manually dispense a fair number of medications for one reason or another.

Eyecon by RxMedic is an automated counting system for oral medications that uses barcode scanning technology and “machine vision” to ensure accurate medication dispensing.

Some things that I thought were interesting about Eyecon:

  • It uses barcode scanning technology to ensure that the correct medication is being used, i.e. Eyecon scans the medication barcode against the prescription label. When used properly this a good way to prevent putting the wrong drug in the patient’s bottle.
  • Use of “machine vision” to perform counting. I’m not entirely sure what “machine vision” technology is, but I hear the term often enough; especially when looking at compounding robots. According to the company, Eyecon can “detect pill fragments or foreign matter in the counting platter and alert the operator”. That’s a nice feature.
  • There are separate trays for “sulfa” and “penicillin”. You frequently see tray segregation like this in outpatient pharmacies due to fear of cross contamination and patient allergies. This little feature tells me that the person that designed Eyecon has practical experience in a pharmacy.

Couple of Eyecon videos below. The first shows a general overview of Eyecon from 2010. The second shows Eyecon being used to fill a prescription using barcode scanning technology. There are several videos posted on YouTube. Just search for “Eyecon”.
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Pharmacies and RFID

RFID technology is intriguing in many ways. It offers some advantages over bar code scanning technology, but then again it tends to be more costly and labor intensive. I’ve always thought RFID technology would find significant use in pharmacy practice, but that hasn’t happened. It has found some niche areas in healthcare, but not to the extent that I thought it would.

I read two RFID articles over the weekend, and on the surface they appear to be in stark contrast. But after giving it some thought I’m not so sure that’s entirely true.
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Lexicomp’s new Drug ID mobile module [video]

Lexicomp has a new Drug ID module for their suite of mobile applications.

Based on the Tweet I thought the new application would identify “loose drugs” with the camera on a mobile device like Medsnap, but that’s not the case.
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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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