Jerry Fahrni

Author: Jerry Fahrni

  • Warning labels on outpatient prescription vials not so great after all

    Everyone has seen them, I know you have. Those little colored labels that the pharmacy slaps on your bottle when you get a prescription: “May cause drowsiness”, “Avoid excess sun”, “Do not take aspirin products without doctor approval” and so on. There are a ton of them. I remember seeing them lined up in front of me when I was working retail. Sometimes it became a game to see how many you could fit on the bottle without covering up valuable information for the patient. I’ve also been in pharmacies where the warning labels were simply printed alongside the medication label.

    Well, it appears that this tradition may not be the best way to warn patients about potential issues with their medication. I mean, who really reads those things anyway?

    A small study recently published in the journal PLoS ONE took a look at these warning labels and determined that people really don’t pay attention. Not surprising.
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  • Bar-code-assisted medication administration in the ED

    In reference to the following article:

    Including emergency departments in hospitals’ bar-code-assisted medication administration. Am J Health-Syst Pharm. 2012; 69:1018-1019 (don’t bother trying to access the article unless you have a subscription -#fail)

    EDs are terrible places for medication administration because the healthcare providers are always in a hurry secondary to the nature of this particular patient care area, i.e. emergencies. All too often medications go unchecked during the medication use process. And to make matters worse, the ED is often times the last place to get BCMA in a planned rollout. It’s also the place where things like BCMA get the most pushback from physicians and nurses.

    According to the article “Emergency departments (EDs) are patient care areas that are prone to medication errors. For this reason, we recommend that EDs be considered in any roll-out of BCMA. Studies have shown that the medication administration error rate in EDs is approximately 7%, with 40% of medication errors reaching patients.4,5 The results of these studies suggest that BCMA could reduce ED medication errors, yet this technology is noticeably absent from the ED.” Pretty much what I just said.

    In order to benefit from BCMA you have to be willing to deploy it to all areas of the hospital, including the ED. I heard a similar message earlier this year at the unSUMMIT when one of the speakers said that most facilities are far from 100% BCMA compliant because of areas like radiology, infusion centers, EDs, etc.

    Makes one wonder how accurate things like the 2011 ASHP National Survey of Pharmacy Practice are. Food for thought.

  • Windows haters out in full force following Surface announcement

    I’ve been reading quite a bit online about yesterday’s announcement for Microsoft’s Surface tablet. As I mentioned last night, I’m thrilled. But I can’t say the same for everyone else. For some inexplicable reason there’s a lot, and I mean a lot, of negative press online today in regards to Surface. Some are simply Microsoft haters, others Window haters, and of course there’s the Apple fanboys, and so on.

    Many are comparing Surface to the iPad which is ridiculous as they’re completely different machines. That’s simply not the right comparison to make. I’ve written about my thoughts on that before so I won’t bore you by repeating myself here. Suffice it to say, one is a mobile OS and the other isn’t.
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  • Microsoft announces the Surface tablet

    It’s not often that I become giddy at the announcement of a new piece of technology. I mean let’s face it; everything is pretty run of the mill these days. But tonight I am giddy.

    In case you missed it, today Microsoft announced the Surface tablet. And no, it has nothing to do with the Microsoft Surface we’ve come to know over the past several years (now PixelSense). Why they’re calling it “Surface” is beyond the abilities of mere mortals to decipher. If there’s one thing I’ve learned about marketing folks it’s that they don’t know dick about a great many things. The “new” Microsoft Surface is a slate tablet PC.

    The Surface tablet will be available in two models, RT and Pro. Both will run full versions of Windows 8, RT and Pro respectively, but will utilize different hardware; RT for machines with ARM-based processors and Pro for Intel processors.
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  • Why don’t we hear more about telepharmacy?

    With the ubiquity of smartphones and tablets these days it seems that pharmacy would finally come out of the dark ages and start using these tools to their benefit. I recently read an article at MEDCITY | News  that talked about the use of tablet technology for “telerounds”.

    Telerounds: The sexy idea is about providing a way for patients in a hospital setting to communicate with their physicians even when they are not at the hospital. An early version of the concept in 2005 took the form of physician robots on account of the tablet screens being attached to “robots” that move from patient to patient. A study conducted by Johns Hopkins researchers in 2005 met with positive feedback from patients and the Henry Ford Hospital in Michigan has been testing the concept with patients using iPads equipped with a Apple’s Face Time program, similar to Skype, in post surgery settings. On industry expert rattled off several reasons why it just isn’t practical right now. First, it would assume that surgeons are always available when the patient needs to speak to them. Current reimbursement models don’t support it. Most hospitals don’t grow iPads on trees for patients to use upon admission. It wouldn’t work with physicians since they could not be reimbursed. Still, it might work better when patients are discharged as a solution for providers trying to reduce readmission rates.

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  • How Barcode Scanners Work [Infographic]

    I’ve been meaning to put this up for a while. I thought the infographic below on How Barcode Scanners Work was awesome!

    WaspBarcode.com: “In our world today, we’re accustomed to seeing barcodes, but most of us don’t have the slightest clue as to how these black and white striped graphics work, or even how they are properly read with a barcode scanner. Better yet, how can barcodes boost efficiency and productivity in small businesses? Not to worry. We’ve outlined a few barcoding basics, including how a barcode scanner works in our latest Infographic.”
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  • Cool Pharmacy Tech – PowderSafe Type A Enclosure

    Every Friday I receive a weekly newsletter from CompoundingToday.com. And every Friday I spend a few minutes skimming over the newsletter looking for interesting things to read. Yesterday was no different.

    I still find extemporaneous compounding interesting and like to keep up with what’s going on when I can. Like most newsletters this one contains a little advertising scattered throughout the document. I typically don’t pay much attention to the advertisements, but this week one of the advertisements caught my attention. It was for the PowderSafe Type A Enclosure by AirClean Systems. It’s basically a small tabletop laminar flow hood used for extemporaneous compounding.

    Compounding pharmacies make a lot of custom medications from powdered ingredients. Depending on the physical properties of the powder being used they can be quite “fluffy” and generate a lot of particulate matter in the air. And the last thing you want to do is spend your days breathing in various powders that may ultimately lead to problems.
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  • I have seen the end of operational pharmacists in long term care (#LTC)

    I spent Saturday, Sunday and Monday in Baltimore, MD at the ASHP Summer Meeting (#ashpsm). I was there for work, and didn’t have an opportunity to participate in any of the sessions. I did however get the opportunity to visit a large long term care pharmacy called Remedi SeniorCare just outside the city. This particular pharmacy is using Paxit robots to handle the dispensing needs for well over 10,000 long term care beds throughout the area.

    I am not a fan of robots in general, but I couldn’t help but be impressed with Paxit. The design is groundbreaking, genius and game changing for long-term care pharmacists. My initial impressions were’t exactly flattering, but after watching it run for the better part of an hour, and listening to the owner talk about it, my opinion changed.

    During part of the conversation our tour guide said that the company was able to “lay off five pharmacists” after getting the Paxit machines up and running. My gut reaction was one of anger. Who the heck do they think they are to get rid of pharmacists in a pharmacy! After all, I’m a pharmacist and no machine can replace me. Right? Wrong. Paxit does a fine job of replacing pharmacists in their traditional dispensing role. And it doesn’t make mistakes, it doesn’t get tired, it doesn’t whine about working conditions, it doesn’t show up late or call in sick, it doesn’t need benefits, etc, etc. No, the Paxit robot makes perfect sense in this environment both from a business standpoint as well as a safety standpoint; they’ve been filling prescriptions with Paxit for three years and it hasn’t committed a single dispensing error. I wish I had had such a safety record when I was still a real pharmacist.

    After my initial reaction I realized that the fault lies with ourselves, i.e. pharmacy practice itself. It’s our own fault. We’ve created a system where we can be replaced by a machine under the right circumstances. Anyone that’s been in pharmacy for any length of time could have told you this was coming, but we haven’t done anything to stop it. And by stop it I mean change our practice. I worked in an LTC pharmacy for nearly two years. It’s brain-numbing work. There’s very little need for a highly trained clinician in an LTC pharmacy. You certainly don’t need a highly trained clinician to check bingo cards or make sure all the right pills are in a med drawer. If you think you do, then you’re wrong. Dead wrong.

    Listen up all you pharmacists stuck behind the counter in retail pharmacies or sitting in the “main pharmacy” in a hospital dutifully counting meds as they go out the door. Continuing down the current path of pharmacy distribution is like putting a gun to the head of your pharmacy career. It’s only a matter of time before you’re obsolete, and it won’t be anyone’s fault but your own. It won’t matter for me as the change is probably still 20 years away, but for those of you just starting a new career “in pharmacy”, you should be looking over your shoulder.

  • Observational time-motion study comparing trational med administration to BCMA in an ICU [Article]

    The article below compares medication administration between paper-based medication administration (PBMA), i.e. the traditional method and bar-code medication administration (BCMA). Unfortunately, as is the case with much of the literature in journals these days, the information is quite old. The data for this observational study was collected in two short spans in 2008 and 2009. The numbers are small, but interesting nonetheless. The results pan out as expected. Items of particular interest were that the nurses in the BCMA groupd spent more time talking to their patients compared to the PBMA groupd, but at the same time spent a heck of a lot more time on drug prep. The first item makes sense, but I’m struggling to understand the drug prep numbers.

    The article can be found in the May 2012 issue of Hospital Pharmacy. It is is available for free with registration.
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  • Clearinghouse for pharmacy automation and technology ideas

    My post from last week along with a conversation I had with my brother got me thinking about all the good pharmacy ideas that never see the light of day. I know there are some great ideas out there because I’ve been fortunate enough to see many of them in my travels. My job gives me the opportunity to visit a lot of hospital pharmacies and speak to a lot of pharmacists and pharmacy technicians. Trust me when I say there are a lot of smart people out there that could improve the practice of pharmacy with their ideas.

    So why is it that so many good ideas don’t get the attention they deserve? There are lots of reasons.
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