Our facility is in the process of implementing bar code medication administration (BCMA) at the bedside. A large part of the process involves selecting hardware for the nurses to use on the floor. In addition to bar code scanners, the nurses will need access to computers for documenting not only medication administration, but other patient specific information as well.
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Category: Medication Safety
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Lexi-Comp running on the Android OS
I just saw a Tweet from Lexi-Comp announcing that they have a demonstration video of their ON-HAND software running on the Android platform. And because I’m using a Motorola Droid as my mobile device of choice, this is very exciting news. See the video below. Additional information is also available at the Lexi-Comp website.
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Pharmacist perception of Wikipedia as a drug information resource
The Annals of Pharmacotherpy (Vol. 43, No. 11, pp. 1912-1913): “Approximately 80% of pharmacists use the Internet to obtain drug information.1 Wikipedia, often found at the top of Internet search results, is a free-access, collaborative, online encyclopedia that can be edited by anyone.2 Incidents of vandalism have occurred, since the site allows anyone to contribute. For example, an incident occurred in which a fake biography was created as a joke to implicate prominent writer and journalist John Seigenthaler for the assassination of John F Kennedy. It took about 4 months until the fake biography was detected and deleted by Wikipedia.3 Although Wikipedia does have an internal quality review, the ability of internal editors to find and correct erroneous information may not be timely. As reported by Clauson et al.,4 the information found on Wikipedia may not be complete and accurate, especially in regard to drug information. Published data regarding pharmacists’ use of Wikipedia to obtain drug information is lacking. Therefore, the objective of this study was to measure pharmacists’ use and perception of Wikipedia for obtaining drug information.†– This letter to the editor discusses the results of a questionnaire given to pharmacists regarding the use of Wikipedia for drug information. I was disturbed to read that 28% of respondents reported using Wikipedia for drug information. Strange that it doesn’t appear on any of my drug information resources lists, and never will. I expect better from pharmacists. -
Comments and discussion regarding allergy post
My post from yesterday about allergies spurred some great comments on Twitter from @omowizard and @psweetman. I read the discussion between @omowizard and @psweetman with great interest and wish I would have been awake to participate. Unfortunately I was already counting sheep when the conversation took place. The discussion also made me realize how difficult it is to carry on a serious conversation with the 140 character limit imposed by Twitter. What we need is a place where a conversation can extend beyond the 140 character limit. Oh, wait, we have that; friendfeed. I digress.
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Who should collect allergy information and how should it be done?
A pharmacists review of a patient medication regimen is never complete without a thorough evaluation of the patients allergy history. Unfortunately our hospital information system suffers from the inability to prevent people from being human and making mistakes. Our clinical information system permits ‘free texting’ of allergy information, resulting in misspelled drug names and therefore allergies that aren’t electronically checked against medication orders. You know the old saying: garbage in, garbage out.
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Thinking about Clinical Decision Support (CDS)
I attended at webinar today on “Achieving Meaningful Use – The Importance of Clinical Decision Supportâ€. Overall the information was pretty good. It wasn’t exactly new information, but it never hurts to hear something again. The webinar got me thinking about Clinical Decision Support (CDS).
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For those that need a reason to support CPOE and EMR implementation
Pharmacists see hand written orders like the one below almost daily. The order has to be interpreted by a pharmacist, usually with a little hand waving and guessing (kind of like being a pharmacy Jedi), and entered on the patient’s medication profile before the nurse can access the medication from the automated dispensing cabinet and get it to the patient. Even though I’m used to looking at orders like this, there is simply no excuse for what you see below.
There are two medications contained in the hand written orders below. I double-dog dare you to find them. It’s kind of like a “Where’s Waldo†puzzle. Leave your guesses in the comment section of this post. Good luck.
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Using bar codes and a cell phone camera to avoid food allergies
ScanAvert is an application that uses the camera on your cell phone to read product bar codes and compare the ingredients to a personalized allergy list on the company website. The product was launched at the Health 2.0 conference in San Francisco this week and is apparently still in the beta phase.
Consumers register for the service at our website, creating a profile from the allergy, prescription, dietary requirement/restriction, and illness categories. They may also establish limits on any of the nutritional values, e.g., carbohydrates, calories. In store aisles, customers scan product barcodes, with their auto focus camera phones, to receive instant feedback as to product compatibility/incompatibility and suggested compatible substitutes.
Our technology will enable shoppers to determine that the products they are purchasing for themselves and their families are compatible with their allergic, prescription, or dietary profiles, e.g., void of peanuts, or, do not contain gluten, an ingredient considered harmful to an individual with Celiac Disease.
The value proposition of ScanAvert is its simplicity and ease of use for the numerous and varied demographic populations that will reap its benefits. For the supermarket, restaurant chain, or food service vendor, it is a unique way to distinguish itself from competition and to provide a new and valuable service for a significant portion of their customer base.
ScanAvert uses First DataBank, a well respected drug information source, to check for information on incompatibilities between prescription drugs and substances found in grocery products. This would be a great application for those with food related allergies.
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BCMA vs. CPOE, Which Comes First? Webinar Results
Pharmacy OneSource hosted a webinar “debate” today that had two excellent speakers presenting their cases for which technology should implement first; Computerized Physician Order Entry (CPOE) or Bar Code Medication Administration (BCMA). The webinar was well worth the time.The case for CPOE was presented by John Poikonen, Pharm.D. John is the Clinical Informatics Director at UMass Memorial Health Care, an Academic Medical Center and health system in central Massachusetts. John is an interesting informaticist as he has repeatedly spoken out against the lack of evidence supporting BCMA. It was a good fit for him to argue for CPOE implementation ahead of BCMA. He brought up some great points and presented a fair amount of literature to back them up. You can read more of John’s musings at RxInformatics.com.
The case for BCMA was presented by Steve Rough, the Director of Pharmacy at the University of Wisconsin Hospital and Clinics, and Clinical Assistant Professor at the UW-Madison School of Pharmacy. Steve has done quite a bit of work with bar code medication scanning technology and presented an excellent case for BCMA.
Both presenters had valid reasons and good arguments for their positions. I for one am in favor of both CPOE and BCMA, but would personally push for BCMA ahead of CPOE for several reasons. CPOE requires a much larger investment in resources, both human and financial, when compared to BCMA. There is also a reasonable expectation that BCMA will stop errors at their most vulnerable point, the administration phase. I’ve mentioned this before and Steve brought up some of the very same points in his presentation. Finally, CPOE requires buy-in from physicians in order to be completely successful. And if there is one thing you can count on it’s that physicians will fight you tooth and nail when it comes to technology and change.
You can grab a copy of the presentation slides here.
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Librarians and patient safety
PSQH: “In order to learn whether librarians and information professionals have expanded their involvement in patient safety, the 2007 survey again asked respondents to choose from a list all of the activities in which they participate. In the 2003 survey, only four persons (of 174 total respondents) indicated they had no role in patient safety activities. In 2007, four persons (of 318 total respondents) indicated they had no role in patient safety activities. In 2007, 82.4% of the survey population responds to ad hoc inquiries on patient safety. As in the 2003 survey, this activity ranked first of all the options offered. More than half of persons who responded are also involved in documenting best practices for patient safety from the literature (68.55%), providing targeted alerts on patient safety issues to staff (57.23%), and creating resource guides for patients and practitioners (52.52%).” – During my time as a critical care pharmacist at Community Regional Medical Centers from 2001 – 2006 I spent a fair amount of time in the library researching this and that. Frequently I had to enlist the help of the medical librarian and we soon became friends. Besides being an excellent resource for information, he and I spent quite a bit of time discussing ways to better access and present pharmacy related information. He was a big believer in centralized storage and retrieval of reference material. We didn’t know it at the time, but we were discussing a cloud model. His insight into situations pertaining not only to medical literature, but to patient care was invaluable. He and I have moved on with our careers, he to the VA and me to my current position at KDDH, but I will always remember the value he added to the overall patient care model. I therefore find it all too easy to believe that medical librarians have become an integral part of patient safety initiatives.
