Jerry Fahrni

Year: 2012

  • RFID-initiated workflow control [article]

    RFID-initiated workflow control to facilitate patient safety and utilization efficiency in operation theater1

    Abstract
    Objective
    To control the workflow for surgical patients, we in-cooperate radio-frequency identification (RFID) technology to develop a Patient Advancement Monitoring System (PAMS) in operation theater.
    Methods
    The web-based PAMS is designed to monitor the whole workflow for the handling of surgical patients. The system integrates multiple data entry ports Across the multi-functional surgical teams. Data are entered into the system through RFID, bar code, palm digital assistance (PDA), ultra-mobile personal computer (UMPC), or traditional keyboard at designated checkpoints. Active radio-frequency identification (RFID) tag can initiate data demonstration on the computer screens upon a patient’s arrival at any particular checkpoint along the advancement pathway.
    Results
    The PAMS can manage the progress of operations, patient localization, identity verification, and peri-operative care. The workflow monitoring provides caregivers’ instant information sharing to enhance management efficiency.
    Conclusion
    RFID-initiate surgical workflow control is valuable to meet the safety, quality, efficiency requirements in operation theater.

    I like the concept that the article presents, but take a look in the methods section and note the presence of “palm digital assistance (PDA)”. That made me a little suspicious about the age of the article. Even though it was published in December 2011, it was received by the journal December 4, 2009; received in revised form August 16, 2010; accepted August 27, 2010 and finally published more than a year later in December 2011. So it took two years from the time the article was received until it was published. This just fuels my opinion that methods used to disseminate medical and scientific information is completely outdated.

    _________________________

    1. Computer Methods and Programs in Biomedicine Vol. 104, Issue 3, Pages 435-442, December 2011

  • Great response to “Why pharmacy continues to fail”

    The Cynical Pharmacist (TCP) dropped by my site and left a great comment in response to my  Why pharmacy continues to fail. I don’t know who TCP is, but I hope to meet him in person some day. I get the impression that we would have some great dinner conversation; some pharmacy related, some not.

    You can see more of his musings on Twitter – @TheCynicalRPH

    TCP makes some great points in his comment, and in my opinion his thoughts reflects the sentiment of many pharmacists practicing in the real world. I was going to refer you to the comment, but felt it would be better to post the meat of it below:

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  • Why pharmacy continues to fail

    I’ve been a pharmacist since 1997. The profession of pharmacy, and therefore the basic principals of the practice, haven’t changed in that time. During my career I’ve worked in six different hospitals (1 in operations, 2 as a clinician, 2 general practice, 1 informatics), one long-term care pharmacy, once as a consultant pharmacist in long term care, in retail for two different retail chains, one community pharmacy and as a relief pharmacist for about a year. Looks pretty bad when I put it in writing. What can I say, I get bored.
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  • Android app updates for Medscape Mobile

    Taken from an email I received informing me of the changes. Overall it looks like a pretty solid update.

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  • Med Adherence – Difference between prescribed and dosing histories [Article]

    Annual Review of Pharmacology and Toxicology (2012 Feb 10;52:275-301. Epub 2011 Sep 19) – No big surprise here, but check out the graphs (posted below), especially the second one where you can see the effect poor compliance/adherence has on therapeutic concentration. Crazy.

    Abstract

    Satisfactory adherence to aptly prescribed medications is essential for good outcomes of patient care and reliable evaluation of competing modes of drug treatment. The measure of satisfactory adherence is a dosing history that includes timely initiation of dosing plus punctual and persistent execution of the dosing regimen throughout the specified duration of treatment. Standardized terminology for initiation, execution, and persistence of drug dosing is essential for clarity of communication and scientific progress. Electronic methods for compiling drug dosing histories are now the recognized standard for quantifying adherence, the parameters of which support model-based, continuous projections of drug actions and concentrations in plasma that are confirmable by intermittent, direct measurements at single time points. The frequency of inadequate adherence is usually underestimated by pre-electronic methods and thus is clinically unrecognized as a frequent cause of failed treatment or underestimated effectiveness. Intermittent lapses in dosing are potential sources of toxicity through hazardous rebound effects or recurrent first-dose effects.

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  • Surprise! Pharma says their “digital resources” are good for consumers

    Sirensong

    Reliance on pharma-sponsored digital resources among online U.S. adults is significant. The research found “51% of online U.S. adults (ages 18+) use pharma-sponsored digital resources, such as condition and treatment information, disease management tools, doctor discussion guides, or mobile apps or websites.” This validates that the interactive information and tools produced by biopharma are being utilized and appreciated.

    Use of these materials results in action: a conversation about a prescription drug. The study learned “43% of consumers using pharma-sponsored digital resources have discussed prescription drugs with a doctor, nurse, or pharmacist as a result.” This data point supports the business objective behind providing these interactive resources: generating a conversation with a healthcare professional. Note that the study was fielded online among 6,634 U.S. adults, ages 18+ during Q4 2011.

    For comparison, Prevention Magazine’s Direct to Consumer Study 2011 found that as a result of seeing an advertisement – not necessarily online – 77% of survey respondents talked to a doctor and 23% asked for a prescription.

    How scary is this! Getting consumers to talk about their medication with their physician is a good thing; talking with their pharmacist even better. However, many times this type of advertising (“digital resource”) results in consumers asking about something completely inappropriate. Which, as we all know, can lead to  a physician prescribing an unnecessary medication, using something that they’re not familiar with or prescribing something they wouldn’t consider first line.

    All you have to do is look at the top 5 “patient and caregiver groups to agree that pharma should be involved in online health consumer communities” to understand why this is such a bad idea.

    1. ADD/ADHD Caregivers
    2. Bipolar Disorder Caregivers
    3. Epilepsy Caregivers
    4. Cystic Fibrosis Patients
    5. Rheumatoid Arthritis Patients

    Yikes! Choosing drug therapy is quite a bit different than picking out a book on Amazon and it should be treated that way.

  • Look at the Transformer Prime with keyboard dock

    Nice little review of the Transformer Prime (TFP) hardware at GigaOM. Make sure to check the game play at around 7:55 in the video. The reviewer plugs an Xbox 360 controller into the USB slot on the keyboard dock and uses it to play Shadow Run. How cool is that. 

    I really think the hybrid design of the TFP is ideal for many situations, especially for those people that truly want to carry a single device. As much as I like tablets I find that I still need a keyboard for any significant data entry chores, whether it be with a spreadsheet, word processor, etc.

    I would really like to see tablet PC manufacturers like Lenovo and Samsung do something similar, i.e. a keyboard dock that increases battery life and folds into a laptop style portfolio with the tablet docked. My dream machine would be a Samsung Series 7 Slate with a laptop dock similar to the TFP. It doesn’t appear that Samsung is interested in such a docking solution, but I’m hopeful that a third party will take the hint and do it anyway.

  • Digital edition of U.S. Pharmacist off to a bad start

    I received the announcement below in my email just a short time ago. So being the good little pharmacist that I am, I headed on over to the U.S. Pharmacist website to check it out. Imagine my surprise when I clicked on the digital issue link and was greeted with a “Service Unavailable” message (bottom image). Bummer. Hopefully they’ll get it up and running shortly.

    Update: Looks like they got it working within 5 minutes of me posting this. It’s a nice format. Check it out for yourself here.

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  • Impact of Anti-infective Drug Shortages [Article]

    Clinical Infectious Disease (online January 19):

    Abstract

    Anti-infective shortages pose significant logistical and clinical challenges to hospitals and may be considered a public health emergency. Anti-infectives often represent irreplaceable life-saving treatments. Furthermore, few new agents are available to treat increasingly prevalent multidrug-resistant pathogens. Frequent anti-infective shortages have substantially altered patient care and may lead to inferior patient outcomes. Because many of the shortages stem from problems with manufacturing and distribution, federal legislation has been introduced but not yet enacted to provide oversight for the adequate supply of critical medications. At the local level, hospitals should develop strategies to anticipate the impact and extent of shortages, to identify therapeutic alternatives, and to mitigate potential adverse outcomes. Here we describe the scope of recent anti-infective shortages in the United States and explore the reasons for inadequate drug supply.

    Unfortunately the abstract doesn’t say much and a subscription is required to read the full article [grrr!]. The authors of the article basically evaluate the shortage of anti-infective agents over a multi-year period (2005-2010) and conclude that “anti-infective drug shortages continue to pose significant problems for clinicians and are a rapidly evolving public health emergency.” In addition they call for further research “regarding the clinical impact of drug shortages on patient outcomes”. How would one perform such a study?

    Drug shortages have received a lot of attention lately. Shortages are certainly nothing new, but they seem to have become a bigger issue lately as the sheer number of unavailable medications is staggering. Areas like oncology and infectious disease are particularly hard hit as the number of treatment options in these specialties are limited to start with.

    While there is no doubt that the shortages have impacted healthcare, I tend to agree with the authors of a commentary piece on the article that conclude that " it is difficult to systematically measure the resulting clinical problem or draw quantitative conclusions about differences in outcomes." Sounds overly simplified, but it’s true.

    For more information on drug shortages make sure to visit the ASHP Drug Shortages Resource Center. Over 200 drugs and counting…

  • Yo, wouldn’t a high-tech laminar air flow hood be cool

    We have so much technology around these days. I mean we have real-time patient monitoring, near field communication, telemedicine, smartphones, music and video in the cloud, and so on ad infinitum. So why is it that hospital pharmacies use the same old horizontal hoods that they’ve always used?

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