I am a UCSF School of Pharmacy alum. I consider UCSF Medical Center, along with many other people, to be one of the best medical centers in the country. And, UCSF Medical Center saved my motherâ€™s life with a liver transplant earlier this year. However, I am frustrated with UCSF Medical Center this morning.
The problem addressed by metal RFID of forgotten surgical tools, sponges and towels is a serious one. The Healthcare Informatics Company found in 2008 that in one out of every eight operations, surgical tools are not properly accounted for. Other statistics indicate such items are left inside a patientâ€™s body in between 1 out of every 1,000 and 1 out of every 5,000 operations. When this happens, they can cause infections and require additional operations, putting a patientâ€™s health at risk and costing a hospital time and money. Until now, hospital operating table personnel had to manually count each small item.
The solution comes from a new generation of small RFID tags. These new metal RFID tags are robust enough to be inserted into surgical instruments, towels and sponges at the time of manufacture and can be read from distances of up to two meters. However, they remain compatible with, and safe for the human body. Xerafy, a Hong Kong company specializing in this technology, has recently introduced a new range of such RFID metal tags. Now RFID for surgical instruments allows them to be tracked automatically, through the operation itself and even throughout sterilization and disposal.
Xerafy offers a couple of whitepapers on the subject worth reading. They can be found here.
2011 brought many new and exciting changes not only in my personal life, but in the world of pharmacy and technology as well. Iâ€™ve learned many new things, gained some new skills, made some new friends, explored the world of pharmacy more deeply, traveled more than ever before and discovered that I once again know nothing. I am excited to see what 2012 has to bring.
Below is a list of opinions Iâ€™ve gathered over the past 12 months. Some are pharmacy related, some are technology related, some are personal, and some are just random thoughts. If you donâ€™t agree with my opinions thatâ€™s fine, but I donâ€™t want to hear about it. On the other hand if you have something useful to add please feel free to leave a comment.
A recent article in Pharmacy Times outlines some interesting examples of Sound-Alike-Look-Alike-Drugs (SALAD) causing trouble in pharmacy. Weâ€™ve all seen them, and I’ve blogged about them before. Hydralazine and hydroxyzine represent a prototypical SALAD pair, but there are many others out there; ISMPâ€™s list can be found here (PDF).
Continue reading High-Alert Medications Involved in Wrong-Drug Errors [Article]
And there were shepherds living out in the fields nearby, keeping watch of their flocks at night. An angel of the Lord appeared to them, and the glory of the Lord shone around them, and they were terrified. But the angel said to them, “Do not be afraid. I bring you good news of great joy that will for all the people. Today in the town of David a Savior has been born to you; he is Christ the Lord.
From the Journal of the American Medical Informatics Association1. I was a little shocked by the number of errors, but as you can see in the abstract below, and in the title, the errors were during the administration phase of the medication use process. Seems a bit odd to look at medication errors during administration when talking about automated prescribing and dispensing. Iâ€™m sure there is an explanation in the full article. However that requires a subscription. Interesting nonetheless:
Objective To identify the frequency of medication administration errors and their potential risk factors in units using a computerized prescription order entry program and profiled automated dispensing cabinets.
Design Prospective observational study conducted within two clinical units of the Gastroenterology Department in a 1537-bed tertiary teaching hospital in Madrid (Spain).
Measurements Medication errors were measured using the disguised observation technique. Types of medication errors and their potential severity were described. The correlation between potential risk factors and medication errors was studied to identify potential causes.
Results In total, 2314 medication administrations to 73 patients were observed: 509 errors were recorded (22.0%)â€”68 (13.4%) in preparation and 441 (86.6%) in administration. The most frequent errors were use of wrong administration techniques (especially concerning food intake (13.9%)), wrong reconstitution/dilution (1.7%), omission (1.4%), and wrong infusion speed (1.2%). Errors were classified as no damage (95.7%), no damage but monitoring required (2.3%), and temporary damage (0.4%). Potential clinical severity could not be assessed in 1.6% of cases. The potential risk factors morning shift, evening shift, Anatomical Therapeutic Chemical medication class antacids, prokinetics, antibiotics and immunosuppressants, oral administration, and intravenous administration were associated with a higher risk of administration errors. No association was found with variables related to understaffing or nurse’s experience.
Conclusions Medication administration errors persist in units with automated prescription and dispensing. We identified a need to improve nurses’ working procedures and to implement a Clinical Decision Support tool that generates recommendations about scheduling according to dietary restrictions, preparation of medication before parenteral administration, and adequate infusion rates.
Apparently some Medscape mobile users with iOS 5 have had some issues. Below is the content from an email I received earlier today. Not exactly sure what the problem is as the email didnâ€™t actually say. Iâ€™d be leery of the application until the fix is applied, which according to the email will be sometime in the first week of January. Iâ€™d recommend using something else in the meantime.
This is where pharmacy is with robotics. We should conduct a little research into their cost-effectiveness versus accuracy and speed. Know what I mean?
The articles below come from Current Opinion in Urology, Jan 2012; 22(1)
Article 1 Pages 61-65
Is robotic surgery cost-effective: yes.
PURPOSE OF REVIEW: With the expanding use of new technology in the treatment of clinically localized prostate cancer (PCa), the financial burden on the healthcare system and the individual has been important. Robotics offer many potential advantages to the surgeon and the patient. We assessed the potential cost-effectiveness of robotics in urological surgery and performed a comparative cost analysis with respect to other potential treatment modalities.
RECENT FINDINGS: The direct and indirect costs of purchasing, maintaining, and operating the robot must be compared to alternatives in treatment of localized PCa. Some expanding technologies including intensity-modulated radiation therapy are significantly more expensive than robotic surgery. Furthermore, the benefits of robotics including decreased length of stay and return to work are considerable and must be measured when evaluating its cost-effectiveness.
SUMMARY: Robot-assisted laparoscopic surgery comes at a high cost but can become cost-effective in mostly high-volume centers with high-volume surgeons. The device when utilized to its maximum potential and with eventual market-driven competition can become affordable.
Article 2 Pages 66-69
Is robotic surgery cost-effective: no.
PURPOSE OF REVIEW: Utilization of robotic surgery has increased dramatically in recent years, but there are significant cost implications to acquisition and utilization of robots. This review will evaluate the cost-effectiveness of using robotics in urologic surgery.
RECENT FINDINGS: This study will evaluate studies comparing outcomes for open, laparoscopic and robotic procedures as well as costs associated with these procedures.
SUMMARY: Current studies have not found the robotic approaches to be cost-effective. In order for the robot to be cost-effective, there needs to be an improvement in efficacy over alternative approaches and a decrease in costs of the robot or instrumentation.
One of the problems Iâ€™ve experienced since leaving pharmacy is keeping up with the medical literature. I no longer have unlimited access to pharmacy journals, medical journals, engineering journals, etc; not to mention less mainstream literature.
While looking at the table of contents from my favorite journals and reading through the abstracts has value, it falls short of providing the same level of information one gets from digging into an article, looking at the data, viewing the tables and graphs, etc.
In an attempt to improve my access to information I signed up for a service called MedInfoNow.
MedInfoNow touts itself as â€œA personalized weekly email that quickly summarizes the latest journal article abstracts and citations from MedlineÂ® important to you.â€
MedInfoNow is easy to use. You simply select topics that interest you, the services searches through those topics, puts them into a simple summary and emails them to you once a week. The service provides obvious value by giving me access to several journals in a single location, but MedInfoNow definitely falls short of my expectations. I was already doing much of what the service provides via RSS feeds, Twitter and frequent visits to my favorite informational websites.
The one thing I really need is access to full-text articles. Unfortunately MedInfoNow doesnâ€™t do that. While it does provide links to some full-text articles, those articles are freely available to anyone and donâ€™t require a paid subscription to the journal or MedInfoNow. Bummer.
Is MedInfoNow worth the $129/year Iâ€™m paying? Hardly. My subscription expires in June 2012. I wonâ€™t be renewing.