“What’d I miss?” – Week of October 24, 2010

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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Pharmacovigilance, what’s in a name

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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Drug error occurs, but not for the reasons you’d expect

I was reading through the most recent issue of the ISMP Medication Safety Alert! and came across an incident where a CLINIMIX E solution was infused on a patient prior to being mixed, resulting in the patient receiving a concentrated dose of amino acids and electrolytes. Fortunately no harm was done.

CLINIMIX E is a dual chamber parenteral nutrition (PN) product consisting of two chambers separated by a seal. One chamber contains dextrose and calcium and the other chamber amino acids along with electrolytes. Simply bust the seal, mix the contents with some gentle agitation and hang it on the patient. Nothing could be easier. I loved these types of products when I used to work in the IV room. They don’t fit the bill for all patients, but when they do it sure makes life in the pharmacy simpler. Otherwise you have to make the PN from scratch which can be time consuming.

In the incident described in the ISMP article the CLINIMIX E bag was retrieved from the pharmacy after hours by nursing staff. This type of procedure is common in hospitals that don’t have a 24 hour pharmacy, i.e. small acute care hospitals. I think this type of system is dangerous, and certainly contributed to the mistake, but that’s not what stands out about this error.

The two things that really irritate me about this error are the physician’s directions and the nurses retrieving and starting a PN in the middle of the night. First and foremost, PN is never a life or death medication. Take a look at the ASPEN guidelines if you don’t believe me. PN is something that should only be used after serious consideration, and in a patient that has been NPO for several days. PN should never be used to adjust a patient’s electrolytes, temporarily augment a patients diet when they can eat solid food or to “stimulate appetite”. In this case if the patient needed PN it could have easily waited until morning. And second, the physician in this case wrote for the CLINIMIX E to be given “’if the patient does not eat at least 50% of breakfast.” For those of you that think this order is ok, raise your hand. Now everyone look around and find the people that raised their hands. Make a mental note to never allow them to treat you for anything serious. Again, PN is serious business and not something that should be started based on an “if, then” statement. Either start it or don’t, but don’t write orders for PN that may be interpreted more than one way depending on who’s looking at it.

Errors occur too frequently in hospitals now, we certainly don’t need to make committing them any easier.

Top blog posts and searches from last week (42)

I always find it interesting to see what brings people to my website and what they decided to read once they get here.

Most read posts over the past 7 days:

  1. Best iPhone / iPod Touch Applications for Pharmacists
  2. Automated unit-dose packagers for acute care pharmacy
  3. MedKeeper acquires DoseResponse
  4. What to do, the case of the unhappy pharmacist
  5. Cool Technology for Pharmacy (June 18,2009 – Alaris Smartpumps)
  6. Moving storage around in the “cloud”
  7. Medscape Mobile for the BalckBerry
  8. “What’s I miss?” – Week of October 10, 2010
  9. Micromedex drug information application for the iPhone
  10. Barcodes on patient wristbands

Top related searchterm phrases used over the past 7 days:

  1. “black cloud”
  2. “hospital wristband”
  3. “transparency”
  4. “doseresponse medkeeper”
  5. “dell xt2”
  6. “mansonella perstans”
  7. “facial recognition”
  8. “alaris pumps”
  9. “automed unit dose packaging machine”
  10. “Medscape mobile”

Will the new crop of slate tablets be good for healthcare?

I recently read an article in Laptop Magazine about the most anticipated tablets scheduled to hit the market over the next several months. Some things caught my attention.

First, all the tablets listed were slate models and offered a variety of screen sizes. The smallest screen listed was 7 inches, while the largest was listed at 12 inches. Screen size is important to me so I was glad to see that the idea of larger devices wasn’t completely dead. The second thing was the variety of operating systems offered. Windows 7 and Android were prominent, but a couple of the tablet descriptions didn’t include an operating system. Based on the screen shots and a little web surging it appears that some of the devices may use proprietary operating systems. We’ll have to wait and see. And finally, almost all the tablets listed were clearly aimed at the consumer. In fact the only “enterprise” tablet that made the list was the Cisco Cius. The Cius is an interesting device as it will use the Android OS, a smaller 7 inch screen, 802.11n, 3G and 4G, and Bluetooth. I’m sure the company is hoping to leverage its VoIP and data systems against the needs of business users. In my opinion the Cius would provide significant functionality and potential for increased productivity to those businesses that already employ Cisco phone or data services. It makes sense to integrate tablets into a system that already uses the same infrastructure.

The two tablets that were conspicuously absent from the list were the BlackBerry PlayBook and the HP Slate which are both being marketed as enterprise devices. I love the idea of the PlayBook because it offers real-time video conferencing like the Cius and the ability to pair it with a BlackBerry smartphone to access online content. The potential to tether a smartphone to a tablet is quite appealing to me.
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What to do, the case of the unhappy pharmacist

I read an article today at the CEO Blog of the American Pharmacists Association (APhA) that talks about the predicament of the retail/community pharmacist.

According to the post “Pharmacists feel it when they’re asked to fill hundreds of prescriptions per shift, provide immunizations on demand, make outbound calls to promote adherence with patients and to do so with less technician help because management just saw another big contract pricing level get cut. And pharmacists are feeling less respected as the supply of pharmacists has increased and employers find positions are easier to fill.”
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MedKeeper acquires DoseResponse

It looks like MedKeeper is making a play in the therapeutic monitoring market by acquiring DoseResponse, a web-based outpatient anticoagulation management system from Keystone Therapeutics. The press release can be found here.

Outpatient anticoagulation therapy, i.e. warfarin management, became a big deal when JCAHO made it one of their national patient safety goals a few years back. I’m specifically referring to National Patient Safety Goal 3E: Reducing Harm from Anticoagulation Therapy. If you feel like giving yourself a headache you can read through the entire Abulatory Health Care National Patient Safety Goals (PDF). I wouldn’t recommend it.
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Top blog posts and searches from last week (41)

“What’s I miss?” – Week of October 10, 2010

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. And yes, this is for the week of 10-10-10. Cool!
Continue reading “What’s I miss?” – Week of October 10, 2010