Jerry Fahrni

Author: Jerry Fahrni

  • Accuracy of preparation of i.v. medication syringes for anesthesiology [article]

    Here’s an interesting article from the January issue of AJHP that talks about the accuracy of medication syringes used in surgical procedures. Some of the findings are a bit unnerving: “18% of preparations deviated from the declared dose by ±20%, 8% deviated by ±50%, and 4% deviated by ±100%“. Humans, we’re just not all that good at things like this.

    Accuracy of preparation of i.v. medication syringes for anesthesiology
    Cyril Stucki, Anna-Maria Sautter, Adriana Wolff, Sandrine Fleury-Souverain and Pascal Bonnabry

    Abstract

    Purpose: The results of a study of the accuracy of i.v. medication preparation by anesthesiologists are presented.

    Methods: The accuracy of syringe preparation was assessed by analyzing the contents of 500 unused syringes collected after adult and pediatric surgery procedures. The collected syringes contained various i.v. medication formulations representative of different preparation techniques: atracurium 1, 2.5, and 5 μg/mL and fentanyl 10, 20, 25, and 50 μg/mL, which required serial dilution after withdrawal of the drugs from ampuls; thiopental 5, 25, and 50 mg/mL, prepared by diluting reconstituted powdered drug from vials; and lidocaine 10-mg/mL solution, which was withdrawn directly from the ampul into a syringe. Variances between actual and labeled drug concentrations were determined via a validated ultraviolet–visible light spectro-photometry method.

    Results: Overall, 29% of the evaluated syringes were found to contain drug concentrations outside the designated range of acceptability (±10% of the targeted concentration); 18% of preparations deviated from the declared dose by ±20%, 8% deviated by ±50%, and 4% deviated by ±100%. In one instance, the actual drug concentration was at variance with the labeled concentration by >100%. In 4% of cases ( n = 20), discrepancies exceeded 100%, suggesting not just imprecision but errors in the preparation process, such as incorrect dilution calculations and selection of the wrong medication vial by the syringe preparer.

    Conclusion: Analysis of different i.v. formulations of four medications prepared in syringes by anesthesiologists revealed a high rate of discrepancies between ordered and actual drug concentrations, suggesting a need for increased institutional efforts to prevent errors during the preparation process.

    Am J Health-Syst Pharm. 2013; 70:137–42

     

  • Firefighers in Australia using ingestible capsule to monitor core body temperature

    Equivital LifeMonitor CapsuleEngadget: “A new swallowable pill has been trialled with 50 firefighters in Australia, aimed at monitoring body temperatures and other vital readings when working under extreme conditions. Using Equivital’s VitalSense Core Temperature capsules, they transmit readings to the companion EQ02 LifeMonitor, housed on the chest. This then sends data on skin temperature, heart rate and respiration rate to an external computer.”

    The ingestible capsule works in conjunction with Hidalgo‘s Equivital belt. According to medGadget the belt is the same one “used by Felix Baumgartner in his brilliant Red Bull Stratos jump”.

    I have to admit, this is both creepy and cool all at the same time. The capsule, along with all the tech wizardry is made by Equivital.

    Image credit news.com.au

  • BMTS Corp goes down for the count and takes Demolizer II with it

    Way back in November 2011 I posted about a cool pharmacy technology called the Demolizer II, a sharps waste eliminator system of sorts. That’s not the interesting part though. That particular post has generated more comments than any other post I’ve ever written. As of this moment there are 32 comments attached to it, mostly bad.

    Starting last month comments mentioning BMTS going out of business started to appear.

    Mike – December 26, 2012 at 5:27 pm
    BMTS, a public company appears to be out of business. They have not filed a report with the SEC since the third quarter of 2011.

    John – January 22, 2013 at 11:35 am
    The IRS has placed locks on the office doors at BMTS due to back taxes. Not sure what the future holds for these guys but its not good at this point.

    Sharon Wagner – January 22, 2013 at 11:38 am
    I just spoke with the owner of the company, John Bricken, who apologized profusely, told me that the company is in financial dire straits and told me to do whatever I have to do because he has no way of helping me. I point blank asked him if I purchased a very expense piece of equipment that is now useless and his respose was, “yes, I’m afraid so”. I asked if there was any possibility that we would be able to eventually get the containers and use this device again and he told me if he was a betting man, he’d say no. The long and the short of my conversation with Mr. Bricken was that we might as well throw our Demolizers away because the company is going belly up! At least someone was finally honest with me!

    Kind of sad really as the Demolizer II was a pretty cool product.

  • Quick review of things worth reading this week

    I missed my regular Saturday morning coffee post yesterday for a couple of reasons. I have a cold that has been kicking my butt all week. Not sure why this cold feels particularly weighty, but it does. Is it that I’m run down or that I’m aging? I pray that it’s the former, but fear that it is the latter. My good friends acetaminophen, antihistamine and decongestant have helped me through the week. Top that off with one of the worst travel weeks I can remember in a while and I’m ready for a day on the couch.

    Yesterday was a bit of a reprieve as I found myself in Los Angeles visiting my daughter and watching the UCLA men’s basketball team lose to Oregon in an exciting game. I would have preferred that UCLA won, but at least I had some downtime with my family and the weather in Los Angeles was spectacular.

    However, life goes on and there were at least a few things I read this week that are worth sharing:
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  • Cool Pharmacy App – MediSafe Medication Reminder [#android]

    MediSafeI came across this app the other day and thought it was pretty interesting. The app, MediSafe Medication Minder, is part of the MediSafe Project. The website isn’t very informative, but it’s worth checking out.

    What’s the MediSafe app all about? Well, this pretty much sums it up: “It’s simple. When it’s time for you to take your medication, the app will remind you. You can also update your app manually. Your caretaker is notified if you don’t check in, so they can remind you only if needed.” The application also supports barcode scanning. Pretty cool stuff.

    I’m not convinced that these apps work for everyone when it comes to improving medication adherence, but I think they have their place and should be an option for those that are comfortable using mobile technology.

    You can grab it for free on Google Play. I think I’ll download it and give it a whirl.

  • Saturday morning coffee [January 12 2013]

    Welcome to my first Saturday morning coffee post of 2013. Here are some of the tabs that are open in my browser this morning along with some random thoughts….

    The coffee mug below was a Christmas present from my youngest daughter, Mikaela. Apparently she reads my blog; yeah, I’m as surprised by that as anyone. She thought I needed a customized coffee mug to go along with my Saturday morning coffee post. I’m thrilled to be displaying it here today for the first time. I had to move it down because it deserved an image from both sides.

    Christmas SMC Mug
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  • Pharmacy tabletop unit-dose packager comparison [table]

    Tabletop unit-dose packagers don’t get much respect, but have you ever been in a hospital pharmacy servicing more than 100 beds that doesn’t have one? I haven’t. Not to say that every pharmacy out there has one, but they’re certainly prevalent.

    The Cadet by Euclid is pretty much synonymous for “tabletop unit-dose packager” in the pharmacy world. It’s akin to how people use the term Xerox to refer to any copy machine, or iPod for any mp3 player. So don’t be surprised if someone refers to your tabletop unit as a “Euclid” regardless of which one you have.

    Anyway, I was doing a little research on the subject and thought I’d share my findings with you (table below). The one piece of data I don’t have is price; companies aren’t exactly transparent with that type of thing.
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  • The impact of prescription time guarantees on patient safety

    I came across an interesting article at the ISMP website this morning. The article details the results of a community pharmacy survey looking at what impact policies and procedures related to guaranteed prescription fill times have on medication errors. The results are predictable and scary.

    “Eighty-three percent of pharmacists working at pharmacies with advertised time guarantees reported that the time guarantee was a contributing factor to dispensing errors; almost half of them (49%) felt this contributing factor was significant. In fact, 44% of pharmacists working in pharmacies with time guarantees reported a dispensing error they were personally involved in, which was directly attributed to rushing to fulfill the time guarantee.”

    That right there is reason enough to not allow time guarantees when it come to filling a scripts.

    Read the rest of the article, especially the table of pharmacists’ perspective on time guarantees. It’s worth a few minutes of your time.

    Afterthought: Why do pharmacists continue to work in this environment? Do they like the work most of the time, and only hate it some of the time? I used to know a few pharmacists that worked in the retail sector of pharmacy, but they’ve all moved on. A couple went to work for PBM’s and two abandoned the profession altogether: one left pharmacy to become an accountant – he’s much happier these days – and another one just quit. I don’t know what she’s up to these days, but the last time we spoke she was dabbling in interior design.

  • Year end thoughts 2012

    fathertime_babynewyear2This is my final post of 2012. Random thoughts about things that I’ve seen, heard and/or read over the past twelve months.

    Twenty-twelve was an interesting year for the Fahrni clan, and not in a good way. We lost one of our own and had some bad things happen. We also had some good times, but it won’t be a year that I’ll miss all that much.

    We all survived the Mayan Apocalypse

    We experienced the last repeating date of the century: 12-12-12
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  • Cool Pharmacy Technology – Diana Hazardous Drug Compounding System

    I came across the Diana Hazardous Drug Compounding System from icumedical while doing a little internet surfing the other day. As the name implies it’s a small, closed-looped system designed for compounding hazardous medications, i.e. chemotherapy.

    The “Diana System” utilizes a dual channel system, one for small volume and another for larger volumes. It’s a little difficult to understand exactly what the device does without seeing it in action, which is what the video below is for. It’s a pretty cool concept. I like the fact that it’s compact and needleless, but there are a couple of things I’d like to see added to the device. It appears that there is a lot of manual programming with the “Diana System”. It would be nice if it was integrated with the pharmacy information system so that it could utilize barcode scanning to automate the programming, much like what we see on the newer generation of smart pumps that are hitting the market.

    From the website:

    Accurate, safe, and efficient hazardous drug compounding technology right at your fingertips.

    • User-controlled automated compounding for maximum accuracy & safety. Unlike automated technologies that require huge investments and do not fit within existing workflows, the Diana system cost-effectively keeps pharmacists and technicians in control of the compounding process from beginning to end.
    • Closed system assures safety of clinicians and the sterility of the mix.The Diana system fits under the hood of your biological safety cabinet and protects clinicians from exposure to hazardous drugs and accidental needlesticks while protecting the patient preparation from exposure to environmental contaminants.
    • Reduces risk of repetitive stress injuries. Free up pharmacists and technicians from many of the repetitive motions required during preparation and reconstitution and reduce the stresses and injuries that can occur as a result.
    • Increases efficiencies and reduces drug waste. By helping you improve the efficiency of high-volume compounding, the Diana system can deliver workflow efficiencies while helping you reduce drug waste by extracting every drop of drug from every container.