Lately I’ve found myself thinking about how pharmacists are involved in healthcare. Despite popular belief pharmacists do more than simply work in the pharmacy.

Throughout my career I’ve become accustomed to people viewing pharmacists as the stereotypically person behind the counter at the drug store “counting pills”. While that’s not all pharmacists do, I’ve learned to live with the general publics simplistic view. I don’t think most people realize that pharmacists are involved in every aspect of a patient’s care. If you’ve ever been in a hospital, received a prescription medication, had a loved one in a long term care facility, received intravenous medications at home like total parenteral nutrition (TPN) or antibiotics, received an albumin or intravenous immunoglobulin (IVIG) infusion in an outpatient infusion center or met with a pharmacist in a clinic setting for a medication therapy management (MTM) session, then you’ve been touched by a pharmacist.
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I was planning on writing a rant this morning about lack of motivation, leadership and dumbasses – hey, I was in a fould mood when I got up – but then I opened an email from a friend. He asked me “How can retail pharmacists get involved in this [pharmacy informatics] industry?”. My first thought was to say that retail pharmacy would be the death of our profession and that they have no business getting involved in pharmacy informatics. Harsh I know, but I told you I was in a foul mood.

Then I did something I rarely do, I thought about the question a bit more before answering. After some time I came to the conclusion that retail, or more generally outpatient, pharmacy is exactly where more automation and technology is needed. I follow a few retail pharmacists on Twitter and one generalization I can make from reading their Tweets is that they all pretty much hate their jobs. Why? Because they spend precious little time working as pharmacists, instead spending most of their time physically filling prescriptions, chasing insurance claims, etc.

What retail pharmacy needs is a super-sized dose of pharmacy automation, technology and greater pharmacy technician involvement. Nowhere in pharmacy is there a greater need for automation and technology than outpatient services. Much of what’s done in the outpatient pharmacy setting does not require a pharmacist. This echoes the words by Chad Hardy last week on the RxInformatics website. Chad states “The longer we rely on pharmacists to run the entire supply chain, the higher our risk of obsolescence.” He’s absolutely right, although the article he references insinuates that pharmacists will become obsolete secondary to technology. Nay, I say. Technology in the outpatient arena can offer pharmacists the opportunity to break away from the mundane and do a little more hands on patient care. In addition, the drive to implement automation and technology in the retail setting creates the perfect job opportunity for pharmacists interested in informatics.

Of course we’ll have to prove to the retail boys upstairs that they can save money by using pharmacists in a more clinical role, but that’s what business cases are for. Unfortunately I couldn’t write a business case to save my life. In fact, a colleague of mine told me that pharmacists are terrible at creating business cases. I suppose that’s true as most of us didn’t become pharmacists to practice business. Instead we became pharmacists to provide patient care. Go figure.

 

I’ve used Pyxis PARx before, but only in combination with a carousel storage system. I recently had the opportunity to play with the standalone version of PARx and all I have to say is yikes!

The system utilizes an older version of Windows Mobile on a clunky Motorola handheld. To get from log-in to a useful place in the application required me to go through no less than four screens. The touch screen was unresponsive and difficult to use, the device was painfully slow and the connectivity was lacking.

So, to sum up my experience with PARx – used with carousel technology it’s great, but try to use the standalone product and you might find yourself spewing profanity.

 

 

UCSF: “Although it won’t be obvious to UCSF Medical Center patients, behind the scenes a family of giant robots now counts and processes their medications. With a new automated hospital pharmacy, believed to be the nation’s most comprehensive, UCSF is using robotic technology and electronics to prepare and track medications with the goal of improving patient safety.

Not a single error has occurred in the 350,000 doses of medication prepared during the system’s recent phase in.

Robotics is nothing new, but it seems like everyone is taking notice of the new robotics in the pharmacy at UCSF. I suppose all the people pointing it out to me has something to do with the fact that UCSF School of Pharmacy is my alma mater, but you never know. Anyway, I’m pleasantly surprised to see UCSF taking such an active role in advancing pharmacy practice. When I spoke with some colleagues sill working for UCSF a little over a year ago they were still practicing pharmacy invented in the dark ages. Not any more.

Now I’m trying to get a hold of someone at UCSF that will let me stop by for a tour, and all of a sudden no one knows me. Poetic justice I suppose.

 

Opened my spam folder today and found an email announcing the availability of Medscape for Android. While it’s not my favorite drug information resource, it’s decent and it’s free. The application can be downloaded here.

Medscape Mobile is also available for the iPhone, iPad and BlackBerry, just in case you don’t have an Android device.

 

I spent some time recently speaking with the director of pharmacy (DOP) from a large acute care facility about operations and various dispensing models. In this particular instance, the hospital utilizes a cartfill model, decentralized pharmacists in satellites to handle first doses, batched IV’s and automated dispensing cabinets for pain meds and other “PRN” medications.

At one point the conversation drifted toward a discussion of using a cartless dispensing model. The DOP wasn’t a fan. The reason cited was a fear that utilizing automated dispensing cabinets in a cartless model would create a workflow logjam in the pharmacy as the entire day would be dedicated to “massive ADC [automated dispensing cabinet] fills”. I understand the thought process, but have found through experience that this simply isn’t true. In a well-constructed workflow a cartless model is quite efficient.
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I’ve been conversing with several pharmacists about the future of pharmacy practice, specifically about the PPMI developed earlier this year by ASHP. This is a sharp group of people, but what I continually hear is the same thing I’ve heard for a number of years. While I’m not as experienced as many of my esteemed colleagues due to a late start to my career, I have worked in several acute care facilities. I’m not sure who said it, but Einstein gets credit for defining insanity as doing the same thing over and over again and expecting different results.

The literature presented in support of a new practice model is, in reality, based on current practice. It’s all looking at how best to apply the pharmacist’s current knowledge and resources to the current practice model. Economic outcomes improved by a pharmacist; great, but not new. Improved patient outcomes with a pharmacist in a team approach; awesome, but not new. Use a pharmacist as a prescriber; cool idea, but not new. These models are easily ten years old and we’re still talking about them as if they were new ideas. See a trend here? I think this is exactly what Einstein had in mind when he defined insanity.
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It’s been a good week in the world of non-pharmacy. ASHP Midyear 2010 is behind us, but the work generated from that meeting has just begun. And 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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Without question there is a lack of advanced automation and technology in the acute care pharmacy setting. Spend some time in several acute care pharmacies if you don’t believe me. There’s clearly a need for it, but it’s just not being used.

I am a fan of automation and technology in any setting, but especially in the acute care pharmacy. I believe that the continued use, development and advancement of pharmacy technology should be a key component of any plan to change the current pharmacy practice model. Unfortunately, the situation is problematic because current pharmacy technology is either poorly designed for the needs of the pharmacy or the pharmacy in which it is used has a poorly designed workflow that doesn’t take advantage of it. Why is that? Who’s to blame; someone, anyone, no one? Valid questions.
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I read an interesting discussion about pharmacovigilance (PV) software a few weeks ago on one of the pharmacy listservs I belong to. The conversation struck me as odd because much of it sounded an awful lot like a discussion on clinical decision support (CDS). This led me to wonder whether or not PV and CDS are the same thing, completely different or subsets of one another. I am not familiar with the term PV myself, so I set out to gather some information. And here’s what I found.
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