Jerry Fahrni

Author: Jerry Fahrni

  • Is robotic surgery cost-effective? Depends on who you ask.

    imageI thought this was very interesting. Dueling robots?

    This is where pharmacy is with robotics. We should conduct a little research into their cost-effectiveness versus accuracy and speed. Know what I mean?

    The articles below come from Current Opinion in Urology, Jan 2012; 22(1)

    Article 1 Pages 61-65

    Is robotic surgery cost-effective: yes.

    PURPOSE OF REVIEW: With the expanding use of new technology in the treatment of clinically localized prostate cancer (PCa), the financial burden on the healthcare system and the individual has been important. Robotics offer many potential advantages to the surgeon and the patient. We assessed the potential cost-effectiveness of robotics in urological surgery and performed a comparative cost analysis with respect to other potential treatment modalities.

    RECENT FINDINGS: The direct and indirect costs of purchasing, maintaining, and operating the robot must be compared to alternatives in treatment of localized PCa. Some expanding technologies including intensity-modulated radiation therapy are significantly more expensive than robotic surgery. Furthermore, the benefits of robotics including decreased length of stay and return to work are considerable and must be measured when evaluating its cost-effectiveness.

    SUMMARY: Robot-assisted laparoscopic surgery comes at a high cost but can become cost-effective in mostly high-volume centers with high-volume surgeons. The device when utilized to its maximum potential and with eventual market-driven competition can become affordable.

    Article 2 Pages 66-69

    Is robotic surgery cost-effective: no.

    PURPOSE OF REVIEW: Utilization of robotic surgery has increased dramatically in recent years, but there are significant cost implications to acquisition and utilization of robots. This review will evaluate the cost-effectiveness of using robotics in urologic surgery.

    RECENT FINDINGS: This study will evaluate studies comparing outcomes for open, laparoscopic and robotic procedures as well as costs associated with these procedures.

    SUMMARY: Current studies have not found the robotic approaches to be cost-effective. In order for the robot to be cost-effective, there needs to be an improvement in efficacy over alternative approaches and a decrease in costs of the robot or instrumentation.

  • Staying up to date with medical literature isn’t easy

    One of the problems I’ve experienced since leaving pharmacy is keeping up with the medical literature. I no longer have unlimited access to pharmacy journals, medical journals, engineering journals, etc; not to mention less mainstream literature.

    While looking at the table of contents from my favorite journals and reading through the abstracts has value, it falls short of providing the same level of information one gets from digging into an article, looking at the data, viewing the tables and graphs, etc.

    In an attempt to improve my access to information I signed up for a service called MedInfoNow.

    MedInfoNow touts itself as “A personalized weekly email that quickly summarizes the latest journal article abstracts and citations from Medline® important to you.”

    MedInfoNow is easy to use. You simply select topics that interest you, the services searches through those topics, puts them into a simple summary and emails them to you once a week. The service provides obvious value by giving me access to several journals in a single location, but MedInfoNow definitely falls short of my expectations. I was already doing much of what the service provides via RSS feeds, Twitter and frequent visits to my favorite informational websites.

    The one thing I really need is access to full-text articles. Unfortunately MedInfoNow doesn’t do that. While it does provide links to some full-text articles, those articles are freely available to anyone and don’t require a paid subscription to the journal or MedInfoNow. Bummer.

    Is MedInfoNow worth the $129/year I’m paying? Hardly. My subscription expires in June 2012. I won’t be renewing.

  • Cool Pharmacy Technology – Eyecon Pill Counter

    1. Scan the bottle
    2. Pour the tablets onto the Eyecon Pill Counter counting platter. The Eyecon Pill Counter uses “Machine vision technology” to count the tablets.
    3. Package the tablets

    That’s pretty simple. Sure beats the heck out of counting the tablets by hand. 5…10…15…20….

    More information on the Eyecon Pill Counter can be found here.

  • GPhA reveals the ARI to address drug shortages

    Did you know there was a Generic Pharmaceutical Association (GPhA)? Well, if you did you’re a step ahead of me because I’d never heard of them until today. According to the GPhA website they represent "the manufacturers and distributors of finished generic pharmaceutical products, manufacturers and distributors of bulk active pharmaceutical chemicals, and suppliers of other goods and services to the generic pharmaceutical industry. GPhA members manufacture the vast majority of all affordable pharmaceuticals dispensed in the United States. Our products are used in nearly two billion prescriptions every year."

    Their Board of Director’s and Executive Committee is a who’s who of generic pharmaceutical manufacturers. Go figure.

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  • Wanna’ tell the FDA about drug shortages? Here’s how

    Here’s the contents of a email I received today from ASHP in regards to drug shortages and the FDA:

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    The Food and Drug Administration Wants to Hear How Drug Shortages Impact Patients

    The Food and Drug Administration has opened a comment period to gain insight about the causes and impact of drug shortages. The agency is seeking feedback as a follow up to a public workshop on the impact of shortages.

    You know first-hand the devastating effect that drug shortages are having on patient care.  Today, ASHP’s Drug Shortages Resource Center lists 208 shortages. That’s nearly the same number of shortages that were reported in all of 2010.

    This is your chance to speak up.

    Write a letter to the FDA that describes your experiences and challenges managing drug shortages.  Here’s what you should include:

    • Impact on patient care.  Share examples from your practice site, such as patients who’ve had to delay care or who’ve experienced adverse affects from second-line therapies.

    • Impact on pharmacy department operations: Discuss how the time spent researching availability of drug products and the redeployment of pharmacists from patient care roles affects the pharmacy department.

    Be sure to ask your colleagues in the pharmacy department as well as your nursing and physician colleagues to join you. Enlist your patients as well. Every voice counts!

    The deadline to submit comments is December 23, 2011. You can post comments on www.regulations.gov or send comments to the Division of Dockets Management (HFA-305), Food and Drug Administration, 5630 Fishers Lane, Rm.1061, Rockville, MD 20852.  See the Federal Register notice for more details.

    Your input and expertise are not only welcome, they are essential to achieving a solution to this critical issue.

    Use the resources below to familiarize yourself with ASHP’s messages on drug shortages.

  • Fun with Lugol’s solution…not really

    A recent ISMP Medication Safety Alert shared various errors that have occurred with Lugol’s solution over the ages. Lugol’s solution is a concentrated liquid form of potassium iodide and iodine known for its use in the treatment of hyperthyroidism. It’s also a dangerous drug because it’s typically dosed in drops, not mL’s.

    Anyway, the ISMP alert shared several examples of oral overdoses with Lugol’s solution secondary to confusion between drops and mL’s. However, mixed in with all the “typical” errors, was the little gem below. Even though the error is more than a decade old, I can’t help but wonder “what the heck were they thinking!”. By the way, my initial read through had me thinking cursive “OS” (oculus sinister, i.e. LEFT eye). With that said, I wouldn’t have actually dispensed it because nothing else on the prescription fits.

    image

    One of the errors reported more than a decade ago involved an order to administer 10 drops of Lugol’s solution mixed with "OJ" (orange juice), but nurses misinterpreted "OJ" as OD (right eye). The patient received several doses of Lugol’s solution in his right eye. The error was identified when the patient complained to the physician about how painful the eye drops were.

  • Effects of interruptions in healthcare [article]

    A recent article in the Journal of the American Medical Informatics Association1 caught my eye. The article, A systematic review of the psychological literature on interruption and its patient safety implications, looks at various tasks and variables associated with interruptions in healthcare. The article is a meta-analysis, and we all know what that means, but it is interesting nonetheless. The authors of the article say that it’s a complex issue, but I think at the heart of the matter interruptions are simply bad. Our brains just don’t multi-task the way we’d like them to, and interruptions cause a break in concentration and therefore a break in our focus. I know it always takes me a few seconds to regain my thoughts when someone interrupts me. This is especially true when I’m performing a complex task. And wouldn’t you consider providing care to patients a complex task? I would.

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  • Secundum artem. Yeah, not so much

    imageMerriam-Webster defines secundum artem as "according to the accepted practice of a profession or trade". In pharmacy it typically goes hand in hand with the preparation of extemporaneous compounds, i.e. when you have to make something from scratch. Pharmacists have been doing this since the profession began. Unfortunately it’s a dying art not only because of lack of interest from younger pharmacists, but secondary to increased regulation and bureaucratic red tape as well. It’s a real shame. To put it in perspective it would be like surgeons no longer performing surgery by hand because of the invention of the da Vinci Robot.

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  • ASHP Midyear 2011–Parting thoughts

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    The ASHP Midyear 2011 Conference basically concluded for me today. I’d like to evaluate the meeting, but honestly have very little to say. This was my first year working in the role of Product Manager for a vendor, and not acting as an “attendee”, i.e I was here for work. The conference took on an entirely different feel this year as I wasn’t able to attend any of the sessions. For the most part I was stuck in the company booth playing the role of demo jockey. It was a strange feeling to say the least. I tried to follow the Twitter stream (#ashpmidyear) a bit, but finally relented and gave up.

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  • Technology in the IV room – its time has come

    The cleanroom environment, a.k.a. the IV room, is one of my favorite areas inside an acute care pharmacy. It is often alive with activity, and can often be the busiest area of the pharmacy. It is also a unique place since the use of intravenous (IV) medications is vital to the successful outcomes of patients, but at the same time can result in some of the most egregious errors in healthcare. While the IV compounding process is under tight control as demanded by USP guidelines, the method of preparation and distribution is decidedly more conventional, i.e. IV rooms often rely heavily on humans. It’s an interesting dichotomy found nowhere else in the pharmacy. It is for these reasons that I find it interesting that pharmacy IV rooms have lagged behind other areas of pharmacy operations in automation and technology. However, that’s beginning to change.

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