Jerry Fahrni

Author: Jerry Fahrni

  • What the NECC fiasco means for automation in pharmacy IV rooms

    According to the CDC website, the fungal meningitis outbreak linked to a tainted batch of steroid injections made by the New England Compounding Center in Framingham, Massachusetts has resulted in more than 500 case reports and 36 deaths (as of November 28, 2012).

    A lot of things happen when something like this occurs. People become fearful, regulatory agencies begin to scrutinize processes and practices, organizations like ASHP begin to formulate statements and create plans to deal with questions and backlash, healthcare systems begin to reconsider how they do things, and people begin to change the way they think. It’s a natural progression. I’ve seen it happen more than once during my career; never to this extent, but I’ve seen it before. It typically leads to practice changes and an entirely new market for consultants.

    The NECC case has caused quite a stir in the pharmacy community. I’ve seen a wild swing in topics of discussion among pharmacists in the acute care setting, i.e. hospitals. Two things in particular have caught my attention: 1) all of a sudden everyone is worried about compounding safety in the IV room, and 2) everyone is talking about robotics. I’ve talked to a couple of friends that are still practicing pharmacy and they are “in the process of looking at IV robots”. Both cited NECC as the reason for their new interest in robotics.
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  • Saturday morning coffee [November 24 2012]

    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….

    The coffee mug to the right is from Denver, Colorado. I have been in Denver twice now, once in the summertime and once in the late fall/early winter. It’s a nice place, but not what you’d expect. Well, at least it’s not what I expected. With a nickname like “Mile High” I expected to be going up and down mountainous roads all the time. Not the case. It is much more flat than I expected. The downtown area has a small town feel to it, and the the 16th Street outdoor mall area was very nice. I found a lot of cool things to do down there in the evening. I also found the Mellow Mushroom pizza joint. Dude, that was some seriously good pizza. One thing is for sure, the views were spectacular. I ended up on the 9th floor of one of the hotels I was in. Outside my window was a picturesque view of show capped mountains and green trees. Overall it’s a nice place to visit. Word of caution though about the airport, it’s a mess at times. I’ve only been through there a dozen or so times and have gotten burned on a few occasions. Consider yourself warned.
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  • Health Robotics ASHP Midyear press release includes mention of RFID

    I came across this press release yesterday. The press release is from Health Robotics, a company that builds and distributes automation and technology aimed squarely at the I.V. room. Their product line includes several robots designed for specialized I.V. room compounding, including i.v.STATION ONCO, i.v.STATION, CytoCare and TPNstation.

    It looks like the company is taking advantage of recent events surrounding sterile I.V. preparation to promote the safety of robotic compounding. They will be presenting data from recent studies from various hospitals across U.S. This all makes sense. But what I found interesting was the quote from Gaspar DeViedma, Health Robotics’ EVP.

    “… I invite all ASHP attendees to compare and contrast our company’s track record now yielding streamlined robotic “live” installations within 60 to 90 days from purchase order; new RFID solutions tracking temperature-controlled I.V. doses from the offsite sterile compounding sites to the hospital pharmacies, on to delivery carts and refrigerated cabinets and all the way to the patient; and finally to witness the new standards in Chemotherapy and Monoclonal Antibody Therapy IV Automation.”

    The emphasis is mine. That part about RFID almost slipped past me when I first read it. RFID is gaining popularity in the pharmacy world. Health Robotics certainly has my attention. I’m curious to see what they’re up to. I hope to have an opportunity to visit their booth at Midyear. I’ll keep you posted.

  • Transforming pharmacy technicians for the future

    I support the use of pharmacy technicians in many roles inside acute care pharmacies. I believe that they are a valuable tool and, when properly utilized, pharmacy technicians can not only improve pharmacy operations and patient safety, but can also give pharmacists freedom to focus on clinical duties and patient care.

    This is why I found a recent article in Pharmacy Practice News so interesting. The article describes a program at Inova Alexandria Hospital in Alexandria, Virginia where the department of pharmacy has developed a system to educate their technicians for expanded roles.

    The program outlined in the article is quite extensive and involved. Why would Inova Alexandria Hospital undertake such a task? It’s simple really. As stated in the article: “The implementation of automation means expanded roles for technicians. Automation promotes safety and accuracy, and when used properly, it can save valuable time, freeing up technicians to work in other areas of patient care and enabling pharmacists to act as direct care providers. The American Society of Health-System Pharmacists’ (ASHP) Pharmacy Practice Model Initiative cites technicians as a cornerstone of the future of pharmacy practice and recommends increased educational requirements for technicians in the future.” I couldn’t agree more.

    The program consists of monthly sessions targeted at educating technicians about medications and disease states. It is designed to promote interactive discussion and teamwork, and appears to have paid off in spades for Inova. According to the article, “The benefits of the technician education forum are numerous. Technicians have become more engaged and accountable for their work and have reported an increased job satisfaction. Furthermore, teaching technicians about correct dosing and safety allows them to become a second set of eyes for pharmacists. Technicians present concerns or questions during daily activities based on topics and concepts previously presented.”

    The article presents examples of how to present clinical information to technicians, and even includes a chart for tips on starting a technician education program of your own. It’s a great article and I encourage everyone involved in pharmacy to take a few minutes to read it.

    The future of pharmacy remains uncertain, but it is clear that technicians are an underutilized commodity in acute care pharmacy. Expanding the role of pharmacy technicians can only improve pharmacy practice and serve as a springboard to launch pharmacist into more patient centric activities.

    cross-posted at Talyst.com

  • Improving medication safety with accurate medication lists and education [article]

    Here’s an interesting article in the October 2012 issue of Joint Commission Journal on Quality and Safety. The article looks at the impact of pharmacy involvement in the medication reconciliation process. In this “study” pharmacy was involved in ensuring an accurate medication list as well as following up with patients after discharge to “enhance patient safety”.

    Overall the results appear positive: improved accuracy of pre-admission medication lists, reduction in medication errors, reduction in 30- and 60-day readmission, and reduction in ADEs associated with readmission and ED visits.

    I only have two minor complaints about the article. First, the data is old. It’s good information, but the impact is diluted by the fact that it was collected nearly 2 years ago. And second, you have to have a subscription to read the entire article, or be willing to shell out $20 to download the full text. Information like this should be open access.

  • Saturday morning coffee [November 17 2012]

    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….

    The coffee mug to the right is part of the “Indivisible” project from Starbucks. “America is about opportunity. About liberty and justice. About a job for every woman and man who wants one. Right now, these jobs aren’t out there, but we believe we can all help change that. When you buy this mug, you help too. Two dollars from the sale of each mug goes directly to Opportunity Finance Network® and the Create Jobs for USA Fund” I don’t buy much from Starbucks because I don’t like their coffee, but it’s my fallback position when I’m desperate. When I saw the mug it reminded me of the iconic symbol of pharmacy, i.e. the mortar from pharmacies famous mortar and pestle. I can’t remember where I picked it up, but I was on the road somewhere because I remember having to stuff it in my carry-on bag to get it home.
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  • Random thoughts on pharmacy, among other things

    I spent a few hours on a plane today. I do all kinds of things when I’m stuck on a plane. I used to work, but that got old after a while. Now I play games, read for pleasure, listen to music, or simply think. Today was a thinking day. I tried playing a game, but my mind was fixated on other things. It’s quite irritating when that happens as I’d rather play games. Anyway, today my mind was focused on pharmacy, which is nothing unusual. I think about pharmacy a lot. Here are some of the things that are floating around my mind:
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  • Excessive acetaminophen dosing in hospitals more common than you might think

    Archives of Internal Medicine: “A total of 14 411 patients (60.7%) were exposed to acetaminophen, of whom 955 (6.6%) exceeded the 4 g per day maximum recommended dose. In addition, 22.3% of patients who were 65 years or older and 17.6% of patients with chronic liver diseases exceeded the recommended limit of 3 g per day.” Arch Intern Med. Published online November 12, 2012

    Not surprising at all. Any pharmacist that’s worked in a hospital setting can tell you that an average patient profile is riddled with potential excess acetaminophen dosing. We used to have order sets for post-op patients that contained acetaminophen 650mg Q 4 hrs prn pain/temp plus Darvocet N-100 2 tablets Q 4 hrs prn pain plus Vicodin 1-2 Q 4 hrs prn pain thrown in for good measure. When pharmacy would object to these order sets the hospital would simply say that no one would ever give all of those to one patient. It’s common sense after all. You’d be surprised what people will do.

    Medscape has expanded information on the article if you don’t have credentials to read the full Archives article.

  • Mobile computing at its finest, the Golden-i Headset

    Not to be confused with the Golden-Showers Headset (post for another time), the Golden-i Headset is a mobile computer worn by paramedics made by Ikanos Consulting, a Nottinghamshire, UK firm. The headset itself is butt ugly, but the functionality is cool. The headset can be controlled by both voice and head gestures.

    How many use cases can you think of for something like this in pharmacy? Several, I’m sure.

    Medgadget: “The headset has a camera and microphone for interacting with applications and to communicate with hospital physicians. The Paramedic Pro software performs voice recognition and allows patient data lookup and entry through voice alone. Remote physicians can see and hear through the headset, allowing them to guide paramedics in stabilizing their patients and starting treatment in difficult cases.”

  • Saturday morning coffee [November 10 2012]

    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….

    The coffee mug to the right is from Chicago, Illinois, obviously. The first time I was in Chicago was in October 2011, so about a year ago. I’ve been in and around Chicago three times since. I find Chicago and the surrounding area fascinating. It is one of the few places that I would consider spending an extended amount of time. I’ve really enjoyed my time there. I say all of this with one giant caveat, and that is that I’ve never been there in the dead of winter. Based on what I know about the winters in Chicago that could be enough to quickly change my mind about staying. One thing that I really need to do before I die is attend a Bears game at Soldier Field. I’ve wanted to do that for a long time now, at least since the days of Walter Payton.

    I have been systematically going through all the coffee mugs in my cupboard to generate these posts. All my mugs used to reside on a single shelf in one of our cupboards. After using a mug for one of these poses, and using it for the weekend, I move it to another shelf; simple way to remember which mugs I’ve used. Well, this morning when I went to retrieve the next mug in line, the cupboard was looking a little bare. It looks like I’ll be out of mugs by the end of the year, which means I need to either get more mugs or find something else to do on Saturday mornings.
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