Jerry Fahrni

Category: Pharmacy Practice

  • Antmicrobial Stewardship, an opportunity for pharmacists

    Interesting little blurb in the March 1, 2015 edition of AJHP that talks about a new California law that will require acute care hospitals to practice antimicrobial stewardship. The law goes into goes into effect July 1, 2015. [Paywall access to the article]

    What’s antimicrobial stewardship? Well, according to the Infectious Disease Society of America (IDSA), the term “refers to coordinated interventions designed to improve and measure the appropriate use of antimicrobials by promoting the selection of the optimal antimicrobial drug regimen, dose, duration of therapy, and route of administration.  Antimicrobial stewards seek to achieve optimal clinical outcomes related to antimicrobial use, minimize toxicity and other adverse events, reduce the costs of health care for infections, and limit the selection for antimicrobial resistant strains.” Pretty straight forward.

    ASHP has an official statement on the subject – The Pharmacist’s Role in Antimicrobial Stewardship and Infection Prevention and Control – which can be found here.

    In the document ASHP states that “pharmacists have a responsibility to take prominent roles in antimicrobial stewardship and infection prevention and control programs in health systems. Pharmacists should participate in antimicrobial stewardship and infection prevention and control efforts through clinical endeavors focused on proper antimicrobial utilization and membership on relevant multidisciplinary work groups and committees within the health system.” I agree. It’s a no-brainer. I’ve always felt that pharmacists were well suited for this kind of thing. After all, most of what antimicrobial sterwardship is all about requires a deep understanding of when and how to use antibiotics.

    ASHP states that it is the responsibility of pharmacists to promote optimal use of antimicrobial agents, reduce the transmission of infections, educate healthcare professionals, patients, and the public. All important tasks, but nothing that a good pharmacist couldn’t handle.

    Unfortunately the new California law doesn’t specify that a pharmacist must participate in the antimicrobial sterwardship program. The law indicates that the stewardship team within hospitals must include “at least one physician or pharmacist who has expertise and training in antimicrobial stewardship“. No guarantee that an acute care facility will opt to include a pharmacist, but at least there’s a chance.

  • 5 years later, my thoughts on pharmacy practice

    I haven’t been a practicing pharmacist in the traditional sense in about five years. I’ve spent the last 19 months as an independent consultant, which has been awesome. Prior to that I was a Product Manager for about two and a half years at a company that dealt in pharmacy automation and technology. Before that I was an IT Pharmacist, which did give me an occasional glimpse of “pharmacy practice”, but overall I figure it’s been at least 5 years since I worked at earnest as a staff pharmacist.

    Recently I took a per diem position in a large acute care hospital as a staff pharmacist. I’m completely content being a consultant, and have enjoyed it very much, but I felt that I was losing touch with the daily grind that is pharmacy. I needed to get my hands dirty again and make sure that I wasn’t giving advice to people that was out of touch with reality. I think it’s important for any consultant to be able to relate to the actual problems that they’re being asked to solve. So for the past few months I’ve been staffing about a day a week. Below are some thoughts on what I’ve seen and heard.
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  • A missed opportunity for safety – why scanning a limited formulary in the i.v. room is a mistake

    “Although some hospitals have chosen to limit use of these systems [IV workflow technology] for focused areas like admixture of chemotherapy or high-alert drugs, there’s no telling when someone might accidentally introduce a high-alert drug when preparing other drug classes that wouldn’t ordinarily be scanned. Therefore, to be maximally effective, the system must be utilized for all compounded admixtures”. (ISMP)

    A couple of weeks ago I wrote about the need to use bar-code scanning technology during compounded sterile product (CSPs) preparation. In my mind it’s a no-brainer. The i.v. room is a dangerous place, and no amount of “double checking” is going to change that.
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  • Are we seeing the final days of standalone systems in pharmacy?

    I’ve used many standalone systems in the pharmacy throughout my career. There was a time when it was considered the norm, but things are starting to change.

    I’ve seen a significant shift in thinking over the past couple of years. Hospital pharmacies are tired of dealing with multiple databases, the inability of one system to easily shuttle information to another, and broken interfaces, i.e. “interface is down”. I’ve talked to several pharmacists over the past few weeks that are no longer looking at functionality, but instead are seeking integrated ecosystems to run pharmacy operations. And they’re willing to give up functionality to get it.
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  • Should you purchase a robot to help compound sterile preparations in the i.v. room?

    The promise of a future where robots handle pharmacy distribution has been around for quite some time. It seems to always be “just a few years away”. I’ve seen my share of robotic distribution systems implemented in pharmacy operations, and the expectation has always been better than the reality.

    But what about using robotic systems in the i.v. room to help make sterile preparations? It seems like the perfect place for this type of tool. Activities in i.v. rooms are dangerous and expensive. If one could utilize a robot to increase safety and decrease cost, then it would seem like a no brainer. Unfortunately it’s not as simple as that.

    Over the past 16 months I’ve observed several different robots – INTELLIFILL I.V. by Baxter, APOTECAchemo by APOTECA, i.v.STATION by Aesynt, and RIVA by IHS – in several different pharmacy environments – inpatient batch processing for multiple hospitals, inpatient patient specific production for single hospital, inpatient chemotherapy, and outpatient chemotherapy. During that time I’ve formed several opinions about the current crop of i.v. room robots; some good, some not so good.
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  • Selecting technology for the i.v. room is no easy task

    Since In the Clean Room was released in October, I’ve received a lot of questions about i.v. room technology. The questions generally focus on a single product or a particular functionality. However, I get a surprisingly large number of people asking me “what’s the best system for the i.v. room”. A simple question. Unfortunately it’s a question that is not easily answered.

    There are several variables to consider when selecting technology for the i.v. room, as well as a number of questions that must be answered during the evaluation process.
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  • #ASHP Midyear final thoughts

    I concluded my time at ASHP Midyear in Anaheim on Tuesday evening. Here are my parting thoughts.

    • The show felt more lively this year than the past couple. It’s hard to explain, but it felt like people were interested in everything around them; a good sign.
    • There was an infusion of new products in the exhibit hall. The “normal” stuff was there, but it is clear that the vendors are once again ramping up. The introduction of meaningful use several years ago put a stranglehold on pharmacy budgets and projects. Everyone put all their eggs in one basket, i.e. all resources redirected to a single goal. During that time hospital pharmacies entered a black hole in regards to the implementation of new technology. It appears that equilibrium has been restored.
    • The “Pharmacy of the Future” Pavilion was anything but the pharmacy of the future. It was nothing more than a giant advertisement for the vendors. Nothing stood out as futuristic.
    • There was virtually no discussion/exhibits for track and trace. Given the state of H.R. 3204, the Drug Quality and Security Act (DQSA), this is going to be a big deal over the next several years. I expected to see more. Then again, the exhibitors have to reserve their booths a year in advance. Hard to plan around that.
    • Didn’t see much to do with Telepharmacy. In fact, I can only think of a single exhibit and that was an outpatient system.
    • The acquisition of CareFusion by BD is interesting for several reasons, but I wonder how the two companies will handle their i.v. workflow management systems. CareFusion has PyxisPrep and BD has BD Cato. Given the limitations of PyxisPrep in its current state it would be hard for me to imagine them not going with BD Cato as their flagship system in the i.v. room. Only time will tell.
    • The acquisition of CareFusion wasn’t the only big move that BD made this year. Apparently BD has partnered with Aethon for medication tracking outside the pharmacy.
    • Envision’s exit from the i.v. workflow management space should be interesting. With their intellectual property for image capture/remote verification going to BD, I wonder what will become of the rest of the product, i.e. the software. The product had a solid foundation and some nice functionality. Hmm, gives me a couple of ideas.
    • APOTECA was conspicuously absent from the exhibitor floor. I found that odd considering that they are one of only two manufacturers of hazardous compounding robots in the U.S. The company also introduced a semi-automated i.v. workflow management system, APOTECAps earlier this year. I fully expected to see the products on display at ASHP Midyear. Not the case.
    • Omnicell entered into an agreement with Baxter to both sell and integrate with DoseEdge. This should allow Omnicell to track CSPs prepared with DoseEdge throughout their suite of products. Everyone is scrambling to get into the i.v. room.
    • As mentioned previously, Closed System Transfer Devices (CSTDs) seemed to be popular among the exhibitors. At least three separate companies – EQUASHIELD, BD, ICU Medical – were showing off their products. I’m not surprised with USP <800> looming in the not too distant future.
    • RFID seems to finally be picking up some steam in pharmacy practice. Several companies were displaying RFID solutions. Several others announced partnerships with those same companies. The most popular areas for RFID appear to be refrigerated inventory management, anesthesia, and medication trays/carts.

  • RxADMIX – a semiautomated manual system for compounding sterile preparations

    RxADMIX has been around for a while. I first mentioned it back in September of 2012 (Cool Pharmacy Technology – RxAdmix).

    Mark and I initially had RxADMIX pegged for inclusion in our report, In the Clean Room, but after several failed attempts to reach the company for information we removed them from our list. That’s a real shame. I thought the company had gone under, but it it appears that RxADMIX is alive and well. I found the YouTube video below, posted on October 31 2014, a couple weeks ago. It looks like the company is doing a bit of new marketing.

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  • Lexicomp’s new Drug ID mobile module [video]

    Lexicomp has a new Drug ID module for their suite of mobile applications.

    Based on the Tweet I thought the new application would identify “loose drugs” with the camera on a mobile device like Medsnap, but that’s not the case.
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  • Pharmacy’s biggest problem in the outpatient space: the retail prescription

    There’s a very interesting article at the Pharmacy Times that talks about the how the “retail prescription” has created a lot of problems for outpatient pharmacies, and it’s not what you think. At least it wasn’t for me.

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