Jerry Fahrni

Month: February 2013

  • Patient collected information and the role of pharmacists

    I had an interesting phone conversation this morning with Kevin Sneed, Pharm.D.(@DeanSneed), Dean at the University of South Florida College of Pharmacy (USF COP). I’ve been trying to connect with Dr. Sneed for a while now, but as you can imagine his schedule is pretty full. Fortunately for me I was able to grab about 30 minutes of his time this morning. And what a great 30 minutes it was. I was so impressed with what he had to say that I’m planning to visit USF COP sometime in the next couple of months to continue the conversation and get a first hand look at what’s going on there.

    While I could expound on our conversation for several pages, one comment that Dr. Sneed made struck me as so profound that I thought I would quickly share it.

    During the conversation we started talking about data, and where it’s coming from. Pharmacy is a data driven science, but never has the data come from so many directions. Dr. Sneed commented that patients are taking control of information these days, and not only are they more informed, but they are generating much of the information that will be used in their care. Patients are becoming connected more and more. This is especially true with the advent of mobile technologies that wirelessly transmit tons of data for everything from exercise regimens, to weight, glucose readings, heart rate measurements, and so on. Dr. Sneed sees a future where patients will present this information not only to physicians, but other healthcare professionals such as pharmacists as well; it will be used as currency to start conversations and facilitate care. I’ve heard people in healthcare refer to data as currency before, but I never really made the connection until now.

    It’s clear that we’re in a new age of heatlchare, and pharmacists need to be prepared to collect this information and utilize it to provide better pharmaceutical care. This may sound superficial on the surface, but it is a very important point. Think of a time, not so far in the future, when pharmacists will have a lot more information about patients at their fingertips. This will likely occur across all pharmacy environments, i.e. outpatient, long term care, acute care, etc. This information will give pharmacists an ever increasing role in direct patient care.

    Something to think about as pharmacists prepare for a future healthcare model that is rich in information provided by their patients. Exciting opportunities lie ahead if we’re prepared to accept them.

  • Saturday morning coffee [February 23 2013]

    So much happens each and every week that it’s hard to keep up sometimes. Here are some of the tabs that are open in my browser this morning along with some random thoughts….

    MUG_MinneapolisThe coffee mug from the right is straight out of the Twin Cities area, i.e. the Minneapolis-Saint Paul in Minnesota. I picked it up at a Caribou Coffee shop in Minneapolis. Apparently Caribou Coffee is a locally owned business in the Twin Cities area. I have no idea really, but that’s what I was told and the website does list a local address (3900 Lakebreeze Ave N., Minneapolis, MN 55429). The coffee is pretty good I thought the mug looked cool. It was the first time I had ever been to the Minneapolis area. I don’t recommend it as a tourist spot in the winter. It was cold boys and girls. The first night I was there it was a cool 0 (zero) degrees F. One neat thing about the trip was that I got a chance to go to the Mall of America. Impressive place.
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  • Automating the oral pediatric syringe filling process [idea]

    oral syringeThe distribution process in pediatric acute care can be quite a bit different than its adult counterpart. The basics are the same on the surface: 1) receive medication orders, 2) fill medication orders, 3) dispense medications. The big difference however is how those medication orders are filled. Pediatric patients require a lot medications in liquid form pulled into oral syringes with patient specific dosages. The bummer is that a vast majority of these syringes are not manufactured in unit of use syringes. In other words you have to do most of the work yourself. It’s a bit of a hassle, but it has to be done. The process of pulling liquid doses into oral syringes has more in common with work done in the IV room than it does with traditional oral solid distribution.

    Recently I was visited a pediatric hospital and watched this process in action. Based on what I witnessed I started to wonder if it was possible to automate the process. And if you could automate it, would it offer any benefit? I suppose it could increase the safety of the process as well as potentially eliminate the need for a pharmacist, freeing them to do something else. Maybe. Maybe not. Regardless, it was worth more thought.

    I started breaking down the process and realizes that it’s more complex than it appears on the surface; it always is. Automating the process would be difficult. Several pieces of the puzzle are already available today, but as completely disparate systems.

    Just thinking out loud, or in writing as the case may be, the process would look a little like this:
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  • Xenex device uses UV light to kill infectious organisms

    I thought this was pretty cool. Simple, yet effective.

    Syracuse.com: “St. Joseph’s Hospital Health Center has stepped up its war against potentially deadly patient infections by unleashing killer robots. The hospital is using two robots, that resemble R2D2 from Star Wars, to kill germs in patient rooms with powerful blasts of ultraviolet light. After trying out the device last summer, St. Joe’s quickly saw a more than 50 percent decrease in its rate of Clostridium difficile – C. diff for short – infections. That highly contagious bug is rampant in hospitals and nursing homes. It can make patients very sick and sometimes kill them.” – That’s a big deal, especially when you’re talking about something as problematic as C. diff.
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  • Who should drive the selection of pharmacy automation and technology?

    Who should be the driving force behind the selection of new automation and technology in a hospital pharmacy? It’s a simple question really, and in my mind there’s only one clear answer: pharmacy should drive the selection of their own automation and technology. That makes sense, right? Well it certainly does to me.

    However, lately I’ve seen a disturbing trend when talking with hospital pharmacies about their selection process. It appears that the IT department – you know, those guys that configure computers and keep your network and hospital servers humming along – has been given a lot of authority in the selection process. Call me crazy, but that seems a little strange to me.

    I’ve always thought of IT as a service department, someone to help you accomplish your goal when it involves technology. As an IT pharmacist it was my job to look at pharmacy automation and technology, evaluate it, weigh the pros and cons, and make a decision based on what was best for the goals of the pharmacy. Once that was done I would get IT involved in the process to make sure we had everything we needed from not only the vendor, but our own hospital IT department as well. If there were gaps we would work together to flesh them out.

    What happens if the IT department is given the leeway to make a decision for the pharmacy on which automation and/or technology they should use? They might make the “right decision”, but if they did it would be the result of sheer dumb luck. The selection process should be one that looks to find the best fit for the pharmacy, one that fits into the pharmacy’s distribution model, one that lines up with existing technology, one that takes future pharmacy plans into consideration, one that will help drive pharmacists out of the pharmacy toward more clinical activities,  one that acknowledges the strengths and weaknesses of the vendor in terms of functionality, usability and support,  and so on. The decision should not be based on who uses the best security protocol, or who prefers Dell Servers over HP Severs, or whether or not the vendor needs network access for support or not, and so on and so forth.

    I truly feel sorry for healthcare systems that ignore their pharmacy personnel when thinking about purchasing new automation and technology for pharmacy operations. In my opinion it’s a recipe for disaster. I certainly wouldn’t want to work in a pharmacy where the tools I used were selected by someone who didn’t even know what I was working on. The next time you have the oil changed in your car, ask the mechanic if he would let the person that installed their computers pick out his tools. I bet you’ll get a similar response to mine, although the language may be a bit more colorful. Better yet, ask a software engineer if he’d let a pharmacist pick out the hardware and software necessary to do his job. It’s a safe bet that he’d look at you like you’d lost your mind.

  • Interview with Healthcare IS [audio]

    I was recently interviewed by Healthcare IS. The audio interview is only about 20 minutes long and covers me answering some general questions about pharmacy informatics, my thoughts on working as an IT pharmacist, etc.

  • Saturday morning coffee [February 9 2013]

    MUG_ArizonaIt’s hard to believe that it’s February already.

    So much happens each and every week that it’s hard to keep up sometimes. Here are some of the tabs that are open in my browser this morning along with some random thoughts….

    Last weekend I was on the road attending my daughter’s Power League volleyball tournament in Sacramento.  My brother Robert filled in for me admirably. I didn’t ask him to take up the reins, but I certainly appreciate him filling in the gap. Thanks, bro. Dig the mug by the way.

    I went through Phoenix, AZ twice this week while traveling for work, which made me think of the coffee mug to the right. It was once of four sent to me by Jason DeVillains last year. Jason is better known to many as The Cynical Pharmacist. Jason and I met via Twitter(@TheCynicalRPH) and have been chitchatting via the web ever since. Perhaps the next time I touch down in Phoenix I can lay over for a day and Jason and I can grab a cup o’ joe together. Jason also blogs over at The Cynical Pharmacist. Check it out.
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  • Crowdsourcing pharmacy: automation, technology, informatics

    redlegoI travel for work a couple of weeks a month, sometimes more, sometimes less. Most of the time I travel by myself, but recently I found myself traveling, albeit briefly, with another pharmacist. He and I ended up in a little pub one night talking about work; products, strategy, gripes, likes, and so on. Typical stuff when two guys get together and talk about work. After a while the conversation turned away from work and toward pharmacy in general. Just two guys talking about stuff that’s interesting.

    A few drinks and several bowls of popcorn later we had covered a lot of interesting pharmacy topics including acute care pharmacy operations, telepharmacy, medication therapy management, insurance company billing, specialty pharmacy practice and so on. There were several interesting ideas figurative sketched out on the back of a napkin that night. This type of comradery is good for the creative process as I’ve mentioned before.

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  • Adding Pharmacists to Primary Care Teams Increases Guideline-Concordant Antiplatelet Use in Patients with Type 2 Diabetes [article]

    Here’s an interesting little tid-bit in the January issue of The Annals of Pharmacotherapy. According to the article “adding pharmacists to primary care teams significantly and substantially increased the proportion of type 2 diabetic patients using guideline-concordant antiplatelet therapy“. Good stuff to be sure. Unfortunately the study only looked at the proportion of patients using antiplatelet therapy at 1-year after engaging the pharmacist. It would be interesting to see data around decreased morbidity, hospital readmission rates, etc to go along with the improved guideline-concordance.

    Abstract

    BACKGROUND: Antiplatelet therapy is recommended as part of a strategy to reduce the risk of cardiovascular events in patients with type 2 diabetes. However, compliance with these guideline-recommended therapies appears to be less than ideal.

    OBJECTIVE: To assess the effect of adding pharmacists to primary care teams on initiation of guideline-concordant antiplatelet therapy in type 2 diabetic patients.

    METHODS: Prespecified secondary analysis of randomized trial data. In the main study, the pharmacist intervention included a complete medication history, limited physical examination, provision of guideline-concordant recommendations to the physician to optimize drug therapy, and 1-year follow-up. Controls received usual care without pharmacist interactions. Patients with an indication for antiplatelet therapy, but not using an antiplatelet drug at randomization were included in this substudy. The primary outcome was the proportion of patients using an antiplatelet drug at 1 year.

    RESULTS: At randomization, 257 of 260 study patients had guideline-concordant indications for antiplatelet therapy, but less than half (121; 47%) were using an antiplatelet drug. Overall, 136 patients met inclusion criteria for the substudy (71 intervention and 65 controls): 60% were women, with mean (SD) age 58.0 (11.9) years, diabetes duration 5.3 (6.0) years, and hemoglobin A1c 7.6% (1.5). Sixteen (12%) had established cardiovascular disease at enrollment. At 1 year, 43 (61%) intervention patients and 15 (23%) controls were using an antiplatelet drug (38% absolute difference; number needed to treat, 3; relative increase, 2.6; 95% CI 1.5-4.7; p < 0.001). Of these 58 patients, 52 (90%) were using aspirin 81 mg daily.

    CONCLUSIONS: Adding pharmacists to primary care teams significantly and substantially increased the proportion of type 2 diabetic patients using guideline-concordant antiplatelet therapy.