JerryFahrni.com Podcast | Episode 8: Loss of Community Pharmacy

In this episode, Jerry talks about some of “new services” being introduced into pharmacy practice, and how these services used to be part of every community pharmacy practice.

Show Notes:
Host: Jerry Fahnri, Pharm.D.

Items discussed in podcast:
TechCrunch article: The Online Pharmacy Race Gets A New Entrant: RobinHealth
Zipdrug
PillPack
RobinHealth

Current setup:
Blue Microphones Yeti USB Microphone – Blackout Edition
Dragonpad Pop Filter
Sony MDR-V150 Headphones

UPMC pilots pharmacogenomics program for heart patients

Twenty years ago pharmacogenomics was supposed to revolutionize the way we practice pharmacy. Unfortunately, the revolution has been slow to evolve. That’s why this pilot program at UPMC is so exciting.

UPMC is piloting a program to perform genetic testing on patients to determine medication response. “At UPMC, doctors are testing for that gene before prescribing medications to patients who receive a stent.” This is one of only a handful of healthcare systems in the country openly performing pharmacogenomic testing.

“UPMC’s goal is to use clinical pharmacogenomics knowledge to individualize patient treatments – part of a broader program at UPMC that officials say could eventually include a wide variety of drugs to improve outcomes for patients…..The genetic and clinical information that is gathered for the PreCISE-Rx program, also feeds UPMC’s data analytics program, which is expected to lead to new scientific insights into how and why drugs work for some patients but not others, and to identify new drug targets.”As

As pharmacists, we should be excited about this. We should also make sure that we’re waist deep in it. My hope is that UPMC has included clinical pharmacists in the program.

This is a great step toward personalized medication.

Source: UPMC pilots pharmacogenomics program, uses gene tests to target medications for heart patients

Study questions what we consider an ‘adherent’ patient

MedicalXpress: “A study at Universidad Miguel Hernández (UMH) in Elche shows that patients defined automatically as “adherent” by dint of collecting their prescriptions each month are not necessarily any better than their “non-adherent” peers at actually taking their medication…. The main finding, then, was that lack of adherence even among those patients who regularly collected their medication was as high as 32%, based on in-pharmacy physical testing and questionnaires.”

Adherence was best when medications didn’t interfere with daily activities. Surprisingly patients taking five or more different medications were better at following their prescribed treatments. Also surprising was that the study shows that “patients are more likely to stop taking their medication if changes are made to the appearance of either the packaging or the medication, with adherence dropping most significantly when changes were made to the size, shape or colour of the pill itself.” Crazy.

Placing equipment in the primary engineering controls (PECs)

Can you place items in the primary engineering control (PEC, aka “the hood”)? I get this question from time to time with regards to IV workflow management systems (IVWFMs). Most (all?) IVWFMs currently on the market utilize various hardware components – cameras, stands, scales, tablets, etc. – inside the hood.

Hardware in the PEC

Things may change in the future, but the bottom line is that there is nothing in the current USP General Chapter <797> that directly addresses the use of automation and technology inside the hood.

However, <797> does, in a general way, address the use of items inside the direct compounding area [DCA], which is where compounding equipment is typically found. Nothing found within the DCA can impact first air, and the equipment needs to be cleanable.

USP Chapter <797> states: “After proper introduction into the DCA of supply items required for and limited to the assigned operations, they are so arranged that a clear, uninterrupted path of HEPA-filtered air will bathe all critical sites at all times during the planned procedures. That is, no objects may be placed between the first air from HEPA filters and an exposed critical site.”

Further guidance may be found in Chapter <797> in a section titled Suggested Standard Operating Procedures (SOPs): “Supplies used in the DCA for the planned procedures are accumulated and then decontaminated by wiping or spraying the outer surface with sterile 70% IPA or removing the outer wrap at the edge of the DCA as the item is introduced into the aseptic work area…. All supply items are arranged in the DCA so as to reduce clutter and provide maximum efficiency and order for the flow of work… After proper introduction into the DCA of supply items required for and limited to the assigned operations, they are so arranged that a clear, uninterrupted path of HEPA-filtered air will bathe all critical sites at all times during the planned procedures.”

If the items being placed in the hoods meet both requirements, i.e. they do not obstruct HEPA-filtered air and can be properly cleaned, then there shouldn’t be an issue.

To ensure that the items are being used appropriately I recommend that users: 1) perform appropriate surface sampling to ensure sterility, and 2) perform a smoke study. Smoke studies are the only way to ensure that items in the hood are not impeding airflow. Take the time to do one for each hood where hardware is used.

Cool Technology for Pharmacy – DOSIS

Not being involved with long-term care (LTC) pharmacies much over the years, I sometimes forget that there’s technology to help with some of the day-to-day operations.

I recently came across an advertisement for a company called Manchac Technologies. The reason it caught my eye is because I had a chance to visit with Manchac several years ago when they were still in their development stage.

Manchac is a company out of Alexandria, LA that specializes in technology designed to automated blister card packaging called DOSIS. “DOSIS products are designed to enhance efficiencies in your pharmacy operations while reducing the opportunities for errors…a robotic solution that fully automates blister cards (filled, sealed, and patient-labeled)”.

Blister cards – aka punch cards, blister packs, etc. – are still prominent in nursing homes and, therefore, a huge part of LTC pharmacies. Large operations will do thousands of blister cards daily. According to information on the DOSIS site, the companies new BP198 machine is “capable of producing 40-55 filled and sealed cards per hour”.

here.

If you want to get a sense of what’s going to be in the chapter, just open it up and search for ‘comment incorporated’. There are just over 100 items. On the flipside, if you want to see what was rejected search for ‘comment not incorporated’. My search found more than 200 items that were rejected. Too bad, really. I thought some of the items that were kicked to the curb were pretty good ideas.