Jerry Fahrni

Author: Jerry Fahrni

  • Teaching Medication Adherence in US Colleges and Schools of Pharmacy [article]

    An article in the American Journal of Pharmaceutical Education takes a look at “the nature and extent of medication adherence education in US colleges and schools of pharmacy”. Surprise, the authors found that “Intermediate and advanced concepts in medication adherence, such as conducting interventions, are not adequately covered in pharmacy curriculums”. Disappointing outcome as medication adherence is one of those areas where I think pharmacists could make a significant impact in not only healthcare outcomes, but reducing costs associated with patient care as well.

    The authors used a combination of surveys to gather information: “(1) a national Web-based survey of faculty members at colleges and schools of pharmacy, (2) a national Web-based survey of student chapters of 2 national pharmacy organizations, Phi Delta Chi (PDC) and the National Community Pharmacists Association (NCPA), and (3) conference calls with a convenience sample of pharmacy preceptors and faculty members.”  While the study isn’t exactly comprehensive, I think it may be representative of what’s really going on in pharmacy schools these days. Let’s face it, the focus is on “clinical” activities of which medication adherence is often overlooked.

    I won’t bore you with the details as the full text of the article is available for free at the journal’s website. What I will say is that it appears that pharmacy schools teach medication adherence, but fail to dig deep enough or allow students to participate in a meaningful manner when given an opportunity to become involved. This is similar to my experience in pharmacy school. The only place I was really exposed to medication adherence was during a six week internal med rotation. Other than that the subject was only covered in passing.

    [cite]10.5688/ajpe76579[/cite]

  • Saturday morning coffee [July 7 2012]

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

    The coffee mug to the right comes straight from Philadelphia. I picked it up at a Starbucks near my hotel during a “Siemens Innovations” conference in 2009. The city is certainly full of history, but not my kind of town. It didn’t help that I was there in August. Yeah, it was hot and humid. On the bright side I had my first authentic “Philly Cheesesteak”, although there was some argument at the hotel when I asked where to get it.
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  • Forcing re-entry of patient ID cuts wrong-patient errors

    You know how websites make you double enter your email address and password when you sign up for a service? Well, apparently that’s not a bad system for making sure you have the right patient during order entry. You’d think we would have figured that out a while back, but then again this is healthcare we’re talking about; equation for healthcare technology “innovation” is ([today’s technology] -10 years).

    The study found that requiring clinicians to re-enter patient IDs resulted in a 41% reduction in wrong-patient orders. Single-click confirmation of patient ID reduced wrong-patient orders by 16%. It’s not all peaches and cream though. The study found that double entry increased order entry by 6.6 seconds. Oh no!

    Understanding and preventing wrong-patient electronic orders: a randomized controlled trial (J Am Med Inform Assoc. 2012 Jun 29 )
    Abstract
    Objective: To evaluate systems for estimating and preventing wrong-patient electronic orders in computerized physician order entry systems with a two-phase study. Materials and methodsIn phase 1, from May to August 2010, the effectiveness of a ‘retract-and-reorder’ measurement tool was assessed that identified orders placed on a patient, promptly retracted, and then reordered by the same provider on a different patient as a marker for wrong-patient electronic orders. This tool was then used to estimate the frequency of wrong-patient electronic orders in four hospitals in 2009. In phase 2, from December 2010 to June 2011, a three-armed randomized controlled trial was conducted to evaluate the efficacy of two distinct interventions aimed at preventing these errors by reverifying patient identification: an ‘ID-verify alert’, and an ‘ID-reentry function’.
    Results: The retract-and-reorder measurement tool effectively identified 170 of 223 events as wrong-patient electronic orders, resulting in a positive predictive value of 76.2% (95% CI 70.6% to 81.9%). Using this tool it was estimated that 5246 electronic orders were placed on wrong patients in 2009. In phase 2, 901 776 ordering sessions among 4028 providers were examined. Compared with control, the ID-verify alert reduced the odds of a retract-and-reorder event (OR 0.84, 95% CI 0.72 to 0.98), but the ID-reentry function reduced the odds by a larger magnitude (OR 0.60, 95% CI 0.50 to 0.71).
    Discussion and conclusion: Wrong-patient electronic orders occur frequently with computerized provider order entry systems, and electronic interventions can reduce the risk of these errors occurring.

  • RFID tracking of refrigerated meds in the pharmacy

    I don’t understand why RFID technology isn’t used more frequently in pharmacies. I’ve talked with a few people about RFID technology, and there’s really not much interest. It’s a shame really.

    Consider this:
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  • Happy 4th of July 2012

    Ah, the 4th of July. Independence Day. The day in 1776 when the Continental Congress gave Great Britain the finger and declared that the thirteen American colonies were no longer a part of the British Empire. America was born.

    “We hold these truths to be self-evident, that all men are created equal, that they are endowed by their Creator with certain unalienable Rights, that among these are Life, Liberty and the pursuit of Happiness. — That to secure these rights, Governments are instituted among Men, deriving their just powers from the consent of the governed, — That whenever any Form of Government becomes destructive of these ends, it is the Right of the People to alter or to abolish it, and to institute new Government, laying its foundation on such principles and organizing its powers in such form, as to them shall seem most likely to effect their Safety and Happiness. Prudence, indeed, will dictate that Governments long established should not be changed for light and transient causes; and accordingly all experience hath shewn that mankind are more disposed to suffer, while evils are sufferable than to right themselves by abolishing the forms to which they are accustomed. But when a long train of abuses and usurpations, pursuing invariably the same Object evinces a design to reduce them under absolute Despotism, it is their right, it is their duty, to throw off such Government, and to provide new Guards for their future security.”

    Well said.

    In addition, the 4th of July is a time for celebration with family and friends. Swimming, talking, playing and lots and lots of BBQ, ice cream, other junk food and so on. This years grub includes a Swiss Meat Roll, BBQ hot dogs, two types of homemade ice cream – vanilla and strawberry, my daughters famous Red, White, and Blue cake, and all the sides that make it fun.

    It’s also a time to enjoy the beauty of fireworks lighting up the night. And believe me, when the Fahrni brothers get together on the 4th there’s sure to be plenty of that.

    Have fun everyone and try not to get carried away. On second thought, don’t worry about getting carried away. Just have fun and be safe.

  • BlueTooth-enabled toothbrush gains FDA clearance…

    Only in American, boys and girls.

    mobihealthnews: “The Beam Brush, a Bluetooth-enabled toothbrush from Louisville, Ky.-based startup Beam Technologies, and a companion app have received 510(k) clearance from the Food and Drug Administration. The FDA on June 21 cleared the product for sale as a Class I medical device on and the company announced the clearance Friday.

    Technically a manual toothbrush, the Beam Brush likely will go on sale this fall for a retail price of $50. However, CEO Alex Frommeyer says the company will offer the product at a pre-launch price of $35 through Beam’s website, Facebook page and Twitter feed. Replacement brush heads will cost $4; the companion app, for Apple iOS and Android, will be free.

    A sensor on board the Beam Brush monitors when and for how long users brush their teeth, and then transmits the data over a Bluetooth connection to the smartphone app.”

  • Prenteral nutrition error [from #ISMP]

    From the latest ISMP Medication Safety Alert!, a mix up between an adult parenteral nutrition (PN) template in an electronic health record (#EHR) and one for pediatrics.

    The big difference between these two is how you order electrolytes; it’s a really big difference.

    The most shocking part of all this was that the error made it’s way through the physician that ordered it, a pharmacist that “entered the PN order” (I’m assuming in the compounding application), the “trained technician” that prepared it – missing the fact that the bag contained a whooping 2600mL of sterile water, the pharmacist that checked it, and finally the nurse that hung it. Swiss cheese anyone?
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  • Maximum effort and repetitive tasks [Article]

    I thought this was interesting as the objective of the effort was to “develop an equation, for repetitive tasks, that uses frequency and/or duty cycle (DC) to predict maximum acceptable efforts (MAE) relative to maximum voluntary efforts (MVE).”

    Huh? Exactly.

    I found this at CafeErgo:
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  • RFID refrigerated storage

    Think high-value items in a pharmacy refrigerator. Just sayin’

     

  • Making data input on tablets simpler, easier (SwiftKey Healthcare)

    Healthcare requires a lot of data input. Unfortunately that’s where tablets fall woefully short, i.e. doing lots of typing. So it’s was with great interest that I read about the new SwiftKey Healthcare keyboard for tablets.

    SwiftKey Healthcare is an intelligent keyboard solution that offers unrivaled next word prediction for healthcare professionals. Built using real-world clinical notes data, it makes text entry on mobile devices fast, easy and tailored to your healthcare context.

    SwiftKey Healthcare is based on the SwiftKey language engine. This uses patented Natural Language Processing and Machine Learning techniques to understand the relationship between words and offer powerful corrections and targeted next-word predictions that run straight from a device.

    My daughter uses texting apps on her Android phone with “next word prediction” and I have to admit, the kid can text pretty stinking fast. While I don’t think an onscreen keyboard will ever totally replace a physical keyboard, things like SwiftKey Healthcare are certainly a step in the right direction. I’m looking forward to giving it a whirl.