Jerry Fahrni

Author: Jerry Fahrni

  • Drug shortages, whose to blame?

    Medscape: “One cause of these shortages, pharmaceutical companies charge, is the amount of time it takes the DEA to approve controlled substance quotas. The DEA has created these quotas for each class of controlled substances and for each manufacturer of drugs containing these agents to prevent their diversion to illegal uses.”

    The drug shortage problem is nothing new. It has become an everyday reality of pharmacy practice. ASHP has established a dedicated website for the problem, and the FDA has gone as far as to create a mobile app to help people track shortage information.

    For most people the idea of a drug shortage seems silly, i.e. just make more. The problem is more complicated than that, however. The causes of drug shortages are multifaceted.
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  • Saturday morning coffee [March 14 2015]

    “There is nothing in which people more betray their character than in what they laugh at.” – Goethe

    So much happens each and every week, and 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….

    The mug below comes straight from Voodoo Doughnuts in Portland, OR. My wife and youngest daughter were up North last week visiting colleges. They surprised me upon their return with a box of Voodoo Doughnuts and this mug. The doughnuts were delicious.

    MUG_VoodooDoughnuts
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  • Applications to assist with Antimicrobial Stewardship

    A couple of days ago I wrote about The California Antimicrobial Stewardship Program Initiative, and how it’s an opportunity for pharmacists to get out and stretch their clinical legs.

    Antimicrobial stewardship requires a lot of real-time surveillance and monitoring of patients, labs and cultures, medication use, and so on. There are basically two ways to accomplish this. One is tedious and inefficient, while the other is smart and efficient.

    The tedious, inefficient method is the one used by many healthcare facilities. Pharmacies in these facilities simply throw pharmacists at the problem by having them look at a bunch of patients manually every day in search of anomalies. It’s very time consuming. It’s like looking for a crooked needle in a needle stack.

    The smart, efficient method involves the use of clinical decision support systems. These systems are connected to several data feeds from other systems throughout the hospital, such as ADT, pharmacy, lab, and so on. The data is aggregated and analyzed against a set of rules designed to find patients with potential problems. These patients are tagged and referred to a pharmacist for follow up, i.e. the pharmacists are only presented with the crooked needles. It’s a much better way to go about things.

    There are several systems on the market designed to perform real-time surveillance and clinical decision support. The list below includes many, but is certainly not exhaustive.

  • Antmicrobial Stewardship, an opportunity for pharmacists

    Interesting little blurb in the March 1, 2015 edition of AJHP that talks about a new California law that will require acute care hospitals to practice antimicrobial stewardship. The law goes into goes into effect July 1, 2015. [Paywall access to the article]

    What’s antimicrobial stewardship? Well, according to the Infectious Disease Society of America (IDSA), the term “refers to coordinated interventions designed to improve and measure the appropriate use of antimicrobials by promoting the selection of the optimal antimicrobial drug regimen, dose, duration of therapy, and route of administration.  Antimicrobial stewards seek to achieve optimal clinical outcomes related to antimicrobial use, minimize toxicity and other adverse events, reduce the costs of health care for infections, and limit the selection for antimicrobial resistant strains.” Pretty straight forward.

    ASHP has an official statement on the subject – The Pharmacist’s Role in Antimicrobial Stewardship and Infection Prevention and Control – which can be found here.

    In the document ASHP states that “pharmacists have a responsibility to take prominent roles in antimicrobial stewardship and infection prevention and control programs in health systems. Pharmacists should participate in antimicrobial stewardship and infection prevention and control efforts through clinical endeavors focused on proper antimicrobial utilization and membership on relevant multidisciplinary work groups and committees within the health system.” I agree. It’s a no-brainer. I’ve always felt that pharmacists were well suited for this kind of thing. After all, most of what antimicrobial sterwardship is all about requires a deep understanding of when and how to use antibiotics.

    ASHP states that it is the responsibility of pharmacists to promote optimal use of antimicrobial agents, reduce the transmission of infections, educate healthcare professionals, patients, and the public. All important tasks, but nothing that a good pharmacist couldn’t handle.

    Unfortunately the new California law doesn’t specify that a pharmacist must participate in the antimicrobial sterwardship program. The law indicates that the stewardship team within hospitals must include “at least one physician or pharmacist who has expertise and training in antimicrobial stewardship“. No guarantee that an acute care facility will opt to include a pharmacist, but at least there’s a chance.

  • Saturday morning coffee [March 7 2015]

    “Your reputation is in the hands of others. That’s what a reputation is. You can’t control that. The only thing you can control is your character.” – Dr. Wayne W. Dyer

    So much happens each and every week, and 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_SMC
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  • 5 years later, my thoughts on pharmacy practice

    I haven’t been a practicing pharmacist in the traditional sense in about five years. I’ve spent the last 19 months as an independent consultant, which has been awesome. Prior to that I was a Product Manager for about two and a half years at a company that dealt in pharmacy automation and technology. Before that I was an IT Pharmacist, which did give me an occasional glimpse of “pharmacy practice”, but overall I figure it’s been at least 5 years since I worked at earnest as a staff pharmacist.

    Recently I took a per diem position in a large acute care hospital as a staff pharmacist. I’m completely content being a consultant, and have enjoyed it very much, but I felt that I was losing touch with the daily grind that is pharmacy. I needed to get my hands dirty again and make sure that I wasn’t giving advice to people that was out of touch with reality. I think it’s important for any consultant to be able to relate to the actual problems that they’re being asked to solve. So for the past few months I’ve been staffing about a day a week. Below are some thoughts on what I’ve seen and heard.
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  • Cool Pharmacy Technology – Intelliguard RFID Solutions from MEPS Real-Time

    Last week I spent some time down south in San Diego visiting a couple of hospitals and speaking with the good folks at MEPS Real-Time. My objective for the visit was twofold: 1) see MEPS RFID Solutions in a live environment, and 2) speak with the people at MEPS and get an inside look at their technology. I was able to accomplish both goals.

    MEPS Real-Time is a company that specializes in providing RFID solutions for healthcare specifically targeted at acute care pharmacies. Their Intelliguard® RFID Solutions product line currently includes a Kit and Tray Management System, Controlled Temperature Cabinets, and a Vendor Management Inventory (VMI) System.

    MEPS_RFID_TAG
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  • Saturday morning coffee [February 21 2015]

    “An error doesn’t become a mistake until you refuse to correct it.” – Orlando A. Battista

    So much happens each and every week, and 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….

    The mug below was sitting next to my laptop filled with chocolate covered espresso beans last Saturday morning, Valentine’s Day. A gift from my lovely wife. Apparently she’s aware of my addiction. It made me smile.

    MUG_Valentines
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  • Saturday morning coffee [January 31 2015]

    “Fast is good, accurate is better.” – unknown

    So much happens each and every week, and 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_SMC
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  • A missed opportunity for safety – why scanning a limited formulary in the i.v. room is a mistake

    “Although some hospitals have chosen to limit use of these systems [IV workflow technology] for focused areas like admixture of chemotherapy or high-alert drugs, there’s no telling when someone might accidentally introduce a high-alert drug when preparing other drug classes that wouldn’t ordinarily be scanned. Therefore, to be maximally effective, the system must be utilized for all compounded admixtures”. (ISMP)

    A couple of weeks ago I wrote about the need to use bar-code scanning technology during compounded sterile product (CSPs) preparation. In my mind it’s a no-brainer. The i.v. room is a dangerous place, and no amount of “double checking” is going to change that.
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