Jerry Fahrni

Category: Medication Safety

  • A couple of articles on medication errors worth reading

    The entire June issue of the British Journal of Clinical Pharmacology (BJCP)  is dedicated to medication errors. It’s worth your time to browse all the articles, but the two below were of particular interest to me.

    Agrawal A. Medication errors: prevention using information technology systems. British Journal of Clinical Pharmacology. 2009 ;67(6):681-686.
    The article covers all the usual suspects when it comes to reducing medication errors via technology. Technologies discussed include CPOE, barcoding, BCMA, medication reconciliation, personal health records, automated dispensing cabinets and decision support systems. No great amount of detail was presented, but the article is well referenced. The entire abstract can be found here.

    Cheung K, Marcel L. Bouvy, Peter A. G. M. De Smet. Medication errors: the importance of safe dispensing. British Journal of Clinical Pharmacology. 2009 ;67(6):676-680.
    The article discusses several strategies for reducing dispensing errors, including barcoding and automated carousels. For each strategy presented, the authors provide some level of support found in the literature. The article is worth adding to your collection. The entire abstract can be found here.

    One final item worth mentioning is a brief editorial written by J K Aronson, the President of the British Pharmacological Society. In it he states “Computerized systems can contribute to prevention as well as detection, but they are expensive and can generate their own forms of error. Simpler and cheaper methods are available and should be widely implemented. For example, error reporting is important in both detection and prevention, and pharmacovigilance has a role to play. However, chief among the preventive methods is education.” – I find this statement both insightful and accurate.

  • Length of time to implement CPOE

    Ok, I’ve taken a little heat since claiming that a “meaningful use” goal of 10% CPOE was weak, so I did a little digging. While collecting ammunition for my defense I came across a little blurb addressing this very issue.

    CHIME070909.ashxiHealthBeat: “Thirty-five percent of hospital CIOs surveyed said it would take their facilities three years to achieve 100% adoption of computerized physician order entry, according to a new survey from the College of Healthcare Information Management Executives. Twenty-seven percent of CIOs surveyed said it would take their hospitals two years to achieve 100% CPOE adoption, while 17% of respondents said complete CPOE adoption would take four years and 13% estimated a five-year time frame to achieve 100% adoption. Only 9% of CIOs surveyed said full CPOE adoption could be achieved in one year.”  – Remember that the “adoption year” timeframe is 18 months away (2011) with a 2012 start date qualifying you for the full incentive potential. This means you could actually wait as late as 2013 for full adoption and still qualify for funding. I realize CPOE is a major project; we’re struggling with it right now. Bu I still think hospitals have enough time to do this right and still get 100% usage. As the saying goes, “nothing worth having comes easy”.



  • The use of speed bumps in healthcare

    speed_bumpsOne day last week I was driving home and happened by a school that doubles as a community swimming pool in the summer. The street had several large speed bumps, forcing me to move rather slowly. I’m usually irritated by speed bumps because they slow me down. This day, however, I was happy they were there because a little boy darted out in front of me. I drive a ¾ ton Ford f250 crew cab pick-up. It’s big and heavy. I have serious doubts that a child would stand much of a chance if they went head-to-head with my truck. Fortunately I was coasting along at a safe 10 MPH secondary to the speed bumps and easily came to a stop at a comfortable distance away. At that moment I was thankful for the safety feature built into the pavement on the road, i.e. the speed bumps.

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  • Is patient safety recession-proof?

    AMNews: “Protecting patients from harm is medicine’s bedrock goal, but the resources required to do so have never come cheaply. With the recession taking its toll on the health sector, doctors and other medical professionals who have tackled problems ranging from hospital-acquired infections to patient falls find their efforts increasingly scrutinized on dollars-and-cents grounds. Ninety percent of hospital CEOs have cut administrative expenses, staff and services amid the recession, according to a survey of more than 1,000 chief executives released in April by the American Hospital Assn. More than three-quarters said they cut capital spending and nearly half scaled back ongoing projects.” – Healthcare administrators don’t want to admit it, but it is clear that you can put a price on patient safety. As I mentioned in a previous post, projects that directly affect patient care are being cut secondary to a lack of funding. The only real question is how much patient safety is worth. I had projects cut that ranged in cost from $10,000 to well over $100,000. What’s the ROI on reduced adverse patient outcomes? Arguments can be made for cost savings associated with several patient safety measures, but hospital administration will argue that this cost saving is “soft money” and simply can’t be tallied in a column. While this is true, we must continue to advance technology, and with it, patient safety. It’s just going to be a little tricky, that’s all.

  • “Ten percent” rule for meaningful use on CPOE is weak!

    Idon’t usually feel compelled to comment on healthcare policy, but something I read recently has me a little miffed. The Meaningful Use Work Group of the ONC’s HIT Policy Committee recommended that 10 percent of orders be entered via CPOE to meet criteria for funding in 2011. Since when is ten percent considered successful. I’ve been through many years of schooling; I’m a veteran pharmacist of more than ten years “in the trenches” and have now been involved with many technology projects in my relatively new role as an IT pharmacist. Never has ten percent of anything been considered acceptable. Try telling your boss you’re only going to give ten percent. Note the reaction on his/her face.
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  • Possible restriction on acetaminophen dosing

    Medscape.com: “The FDA should put new restrictions on acetaminophen, an advisory committee recommended Tuesday, saying the move would protect people from the potential toxicity that can cause liver failure and even death.” – Acetaminophen (a.k.a. Tylenol) is a very safe medication. According to the article “billions of doses of acetaminophen are used safely every year.” That’s billion, with a “b”. So why would you want to restrict it? That’s a good question. I certainly don’t have an answer.

    Here are a few things to consider if you use acetaminophen:

  • Keep the dose to a maximum of 650mg if you’re a healthy adult.
  • Check with your doctor or pharmacist if you have any health related issues prior to using acetaminophen (liver problems are especially problematic).
  • Make absolutely sure there is no acetaminophen in any of the prescription medications you take (i.e. Vicodin, Norco, Tylenol #3, etc).
  • Don’t take acetaminophen more often than every 6 hours unless directed so by your physician.
  • Be cautious when using over the counter (OTC) medications with multiple ingredients. READ THE LABEL. If the item claims to take care of aches and pains, then it probably has an analgesic in it. You would be surprised to learn where acetaminophen pops up.
  • Don’t drink alcohol when taking acetaminophen; your liver will not be happy if you do.
  • When giving acetaminophen to a child, make absolutely sure to read the directions before use and use only the measuring device supplied with the medication. If you need to measure more than the device is capable, either the child is too old for the dosage form or you’re giving the wrong dose.

    • This issue isn’t so much about the safety of acetaminophen as it is about common sense. Use your head people.

  • NQF calls for pharmacists to take greater role in patient safety

    HealthLeadersMedia.com: “Literature shows that when pharmacists are involved in care, the result is improved patient care, fewer adverse events, and reduced costs,” said Andrawis, speaking about Safe Practice 18. “But, in order for that full benefit to be realized, it’s really important that those pharmacists be given appropriate authority, and consequently that they continue to take accountability for patient outcomes.” – The article goes on to say that pharmacists should be involved in all facets of patient safety including leadership, technology and clinical rolls. Pharmacists are uniquely qualified to address patient safety issues. This is especially true when it comes to the pharmacists roll in the medication distribution model and implementation of new technology such as smart pumps, automated dispensing and barcoding. As the public becomes more aware of issues related to patient safety, the pharmacists roll in saving lives (and money) associated with medication errors will become even bigger.

  • The patient centered medical home and pharmacy

    From the Pharmacy Technology Resources (PTR) blog:

    “Patient Centered Medical Home” (PCMH) – is likely to be the best opportunity for aligning physician and patient frustration, demonstrated models for improving care, and private and public payment systems to produce the most profound transformation of the health care system this far. Wait a second – what about the Family Pharmacist or Consultant Pharmacist? How does pharmacy play into this model? What relationships are being formed today between the community retail pharmacy and these home-care physicians? What active correlation or network can be established nationally to group together seamless health-care services between the home-patient, the physician, and the pharmacy?

    First – we’ll say – its ePrescribing with all the industry attention this mode of communication brings between doctors and pharmacists – however – I say it takes more than an electronic network to ensure the proper care is given to the patient. This medical home based model sounds similar to the model from the 1990’s of managed care that was about decreasing costs. Is this system designed to help patients instead of insurers? The relationship between the “local” doctor and the “local” pharmacy is imperative. We have come full circle – where in the 1950’s the relationship between physician and pharmacist was much more prevalent. Today – the home-care doctor can grab his iPhone and digitize the necessary communications with pharmacy for a seamless and completed transaction for the patient. But what about the relationship between the doctor and pharmacist and the periodic medication review for the home-care patient?”

    As I have mentioned before, the technology to provide real-time access to patient data is currently available. This provides a genuine opportunity for pharmacist involvement in the medical home model. The PTR blog recommends pharmacists partner with local physicians using the PCMH model, and I think this is a great idea. This is a golden opportunity for all you pharmacists that want to expand your practice setting. What are you waiting for? The time is now.

  • Beyond technology – nurse/pharmacist collaboration for patient safety

    Advanceweb.com via SafetyNurse on Twitter: “Pharmacists and nurses are essential professionals entrusted with medication safety. However, the medication delivery and other resources provided by pharmacy are not always well received by nursing, and vice versa. Nurses complain medications are not delivered on time. Gurses and Carayon (2007) noted that delays in getting medications from pharmacy as one of the most common nursing performance obstacles. Pharmacists complain they never received the order. Many blame today’s technology while others clamor for more advanced modes of medication delivery. Recently, studies have suggested computerized prescriber order entry can lead to new types of errors, especially during the early phase of technology deployment and dissemination. Technological advancements are not enough to ensure patients’ medication safety; collaboration between nurses and pharmacists is critical.” - I can tell you from years of experience that nursing and pharmacy frequently have issues and continuously play the “blame game.” I can also tell you that a good working relationship between pharmacy and nursing is key to successful patient care. I spent five years in a critical care satellite working closely with nursing. The more time I spent in the unit, the better my working relationship with nursing became. Trust developed and patient care was improved. While it is clear that technology is a tool that can improve patient safety, a solid nursing/pharmacy relationship is necessary to make it successful.

  • Insight into poor handwriting and why EHRs are important.

    Florence dot com: “1. People who prescribe medications should use a system more sophisticated than the pine straw delivery guy’s [pen and paper] to communicate high-stakes drug information. 1,400 commonly prescribed drugs have names that look-alike or sound-alike. People can, and do, die when drug names are confused with one another.

    2. Pharmacies should be able to receive prescription data in a format that does not require the tenacity of a middle-school math teacher on summer holiday to decipher.

    3. Your electronic medication history–housed with your physicians, pharmacy, and any consumer portal you choose–should move seamlessly into hospital data repositories and be accessible, with your consent, during planned and emergent encounters.”
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