Observational time-motion study comparing trational med administration to BCMA in an ICU [Article]

The article below compares medication administration between paper-based medication administration (PBMA), i.e. the traditional method and bar-code medication administration (BCMA). Unfortunately, as is the case with much of the literature in journals these days, the information is quite old. The data for this observational study was collected in two short spans in 2008 and 2009. The numbers are small, but interesting nonetheless. The results pan out as expected. Items of particular interest were that the nurses in the BCMA groupd spent more time talking to their patients compared to the PBMA groupd, but at the same time spent a heck of a lot more time on drug prep. The first item makes sense, but I’m struggling to understand the drug prep numbers.

The article can be found in the May 2012 issue of Hospital Pharmacy. It is is available for free with registration.
Continue reading Observational time-motion study comparing trational med administration to BCMA in an ICU [Article]

Clearinghouse for pharmacy automation and technology ideas

My post from last week along with a conversation I had with my brother got me thinking about all the good pharmacy ideas that never see the light of day. I know there are some great ideas out there because I’ve been fortunate enough to see many of them in my travels. My job gives me the opportunity to visit a lot of hospital pharmacies and speak to a lot of pharmacists and pharmacy technicians. Trust me when I say there are a lot of smart people out there that could improve the practice of pharmacy with their ideas.

So why is it that so many good ideas don’t get the attention they deserve? There are lots of reasons.
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Should healthcare systems offer incentives to improve med adherence?

I saw the article below over the weekend and wasn’t sure how I felt about it. On one hand it’s a good thing for people to adhere to their medication regimens. Medication adherence ultimately leads to lower overall healthcare costs secondary to fewer hospital admissions, fewer lost days to chronic disease “flare-ups”, fewer re-treatments or extended antibiotic courses, and so on. When you think about it like that, it makes sense. On the other hand, you’re telling people that there are no consequences for their own bad behavior. Hey, if you don’t take your medication that’s ok. We’ll give you money each time you do to “encourage you” to do it.

According to the article “cross-study comparisons indicate a positive relationship between the value of the incentive and the impact of the intervention“. So, the more “incentive” I give you the more likely you are to take your medication. Not surprising.

What ever happened to just being a good citizen and doing the right thing? Civic responsibility?

Cool Pharmacy Tech – Real time volume detection in syringes

I received the Tweet below last night from Denis Lebel. The link took me to a YouTube video that demonstrates the use of a camera and software to determine the volume inside a syringe. It’s really cool.

I had an idea like this about 6-8 months ago. I talked it over with a colleague and they said it couldn’t be done. Well it seems the smart folks at Scorpion Vision Software did what couldn’t be done. Surprise! Denis said they’ve been working on it for about a year. Congratulations are in order as I think this is brilliant.

Translated text from the video description: “This video shows a proof of concept that allows the detection volume of syringes in real time thanks to the vision software. This real-time detection, combined with the reading of bar code products can be an important addition to the quality control of the preparation of intravenous medications in sterile chamber in pharmacies of health facilities.

In this video we demonstrate how the Scorpion vision software software identifies the”bar code” that identifies the type of syringe used, the position of the piston and thesyringe body in 3D space and then estimating the volume contained in the syringe.”

Pharmacy needs a new method for sharing non-clinical information

Last week I found myself in Florida for work. I had a little extra time on my hands so I stopped by NOVA Southeastern University to visit with a friend and colleague, Kevin Clausen (@kevinclausen). Kevin is not only a pharmacist, but professor and researcher at the Center for Consumer Health Informatics Research at NOVA Southeastern. He’s one of a select few pharmacists that are dedicated to pharmacy informatics in academia.

Kevin and I talked about a lot of topics, but one topic that was of particular interest was getting information published in journals. As an active researcher Kevin has a laundry list of published articles to his credit, giving him keen knowledge of the process for publishing research in peer-reviewed journals. One thing that struck a chord with me was the effort and time required to get an article published. Apparently it can take multiple article revisions and upwards of a year to get an article accepted by a certain journals.

No one that’s been involved in the process would be shocked by this; not even me. I’ve heard this before from other people in my profession. The problem is that the model doesn’t work for informatics, automation and technology (IAT). The speed at which the field is evolving means that information is often obsolete by the time it hits the peer-reviewed journals.

The basic question is whether or not information about pharmacy IAT requires the same rigors as research aimed at the clinical side of pharmacy. Does a study of turnaround time during pharmacy distribution with carousel technology vs. robotics require the same intense scrutiny that a study looking at the use of an ACEI vs. an ARB in PWD and HTN would?  Not likely. While one could argue that the method of distribution may impact patient care it is unlikely that the impact would be worth little more than a friendly debatable among colleagues.
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UpToDate now available for #Android

The Palmdoc Chronicles:

Android users rejoice. If you are an UpToDate subscriber, you now can download the new UpToDate Android app.

Description
Find clinical answers at the point of care or anywhere you need them! Now you can access current, synthesized clinical information from UpToDate® — including evidence-based recommendations — quickly and easily on your AndroidTM phone or tablet. This app is free to download. However, an individual subscription is required to log in and use it.
Features of UpToDate include:
• Persistent login
• Easy Search with Auto-complete
• Bookmarks and History
• Mobile-optimized Calculators
• Ability to earn CME/CE/CPD credit

This is the first public release of the Android app for UpToDate. Like the first UpToDate iOS mobile app, you need to login and you need an Internet connection. It is more convenient to have a native app rather than access UpToDate from the browser and you get more options than just the browser version. I suppose eventually UpToDate will release an “UpToDate Complete” for Android much like the iOS UpToDate Complete.
Update: It seems that this first release, although a free app, is available only to those who have access to the Google Play store in North America.

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Evernote update for Android is awesome

I received an update for Evernote today on my Galaxy Nexus. And let me just say that it’s awesome. I use Evernote all the time. It’s one of the few services I pay for because it’s the best method I’ve found for collecting notes; all kids of notes. I use it to clip web pages on my tablets (all of them) as well as my smartphone, take hand written notes, collaborate with others via shared notebooks, take audio notes, store journal articles in PDF format, and so on. It’s easy to organize my notes because of the familiar tag system that Evernote uses. Simply put, Evernote is indispensable.

The biggest change with the Evernote update is the user interface. The home page is easy to use and intuitive. In addition it lets you swipe out a hidden menu just off the screen to the right to get to your notes. The navigation is more “swipe friendly” and I like it. It’s really quite slick.
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Ideas, Vision, Innovation: Fantasy vs. Reality

Simply put, I think you need an idea and a vision to be innovative. Sounds simple enough.

I’ve read that good ideas are hard to come by, vision even harder and innovation rare. I don’t buy it. I believe innovation is difficult, but probably not for the reasons you might expect. On the other hand I don’t believe that ideas are hard to come by or that vision is rare.

I think ideas are like change in your pocket and you tend to collect more than you think. If you’re like me, and I believe most people are, you probably have several ideas every day about changing how something is done, how to make something better or what the next big thing should be. You know what I mean. All those moments throughout the day when you say something like “what if they…” or “why didn’t they…” or even “wouldn’t it be cool if …”. You know what I’m talking about, like “wouldn’t it be cool if they filled marshmallows with hot fudge”. Yes, yes it would.
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News flash, not all docs happy with iPad in the hospital setting

Palmdoc Chronicles: “It looks as if most doctors and nurses would rather not touch the iPad at work (or deal with any other kind of tablet computing). They certainly won’t be making it their go-to device. “We had some instances where physicians wanted iPads – thought they wanted them – borrowed them, used them for a few days and returned them,” said Kirk Larson, a vice president and chief information officer at Children’s Hospital Central California, who spoke at the Healthcare Information Transformation conference in Jacksonville, Florida.” – This article caught my attention because I used to work at the facility mentioned in the article (Children’s Hospital Central California). The actual content isn’t really a big deal. Unlike hats, one size doesn’t necessarily fit all when it comes to tablets. Slate tablets really aren’t designed for data input. I ran into this problem nearly two years ago when the hospital I was working for at the time rolled out iPads to the pharmacists. Within a couple of weeks they were asking for their convertibles back (Dell XT2 tablet PCs).

Pharmacy student adherence to a simulated medication regimen

A Tweet from Anthony Cox (@drarcox) led me to this article in the American Journal of Pharmaceutical Education.

In this study, 72 second-year pharmacy students were given “medications” (Starburst JellyBeans) to take with varying administration schedules. The table below shows the results of the little experiment, and it speaks volumes.

Not surprisingly a “once daily” regimen was the easiest to follow, but still resulted in more than 10% of the doeses being missed. As the regimens grew in complexity, the percentage of missed doses increased.

We did a similar experiment with M&M’s when I was a pharmacy student at UCSF. The results were similar, i.e. the more complex the regimen, the harder it was to adhere.

Oh, and these were pharmacy students we’re talking about here. What do you think happens when you ask the average non-healthcare professional to adhere to a medication regimen?

The entire article is available for free here.