Jerry Fahrni

Category: Pharmacy Practice

  • Color labels for pharmacy – Quick Label Systems

    QuickLabel

    I was rummaging through my travel bag and found some items that I collected during the ASHP Summer Meeting back in June. Most of the information had to do with IV room systems, tablet identification, and so on. But there was one item that caught my eye that didn’t fit with the rest: color labels.

    I’ve written about the use of color on pharmacy labels before. It has its place, but in my opinion the major barriers have been cost and label quality. That’s why I was so interested when I saw the booth from Quick Label Systems at the ASHP Summer Meeting. The labels they had on display were spectacular. It’s difficult to see in my photo, but the image quality and label stock are top notch. The labels are tough –  really tough – resistant to water, and don’t smear. Very nice.

    The quality of the label and print gives users the ability to place a crazy array of information on the label, including the ability to embed audio or links to video using bar code technology. It’s pretty cool.

    The company isn’t a pharmacy solution in the traditional sense, but do provide OEM services for other companies. In other words, if you have a need for color labels Quick Label Systems will build color label printers with your name on them.

    Not every product that leaves the pharmacy needs a color label, but they could certainly be useful in the IV room. Using color to differentiate or highlight something that requires special attention like chemotherapy is always helpful to pharmacy and nursing.

    I’ll try to get the rest of my bag’s contents up over the next few days.

  • Medication Therapy Management as a tool for reduced cost of care and fewer readmissions

    A colleague asked me if I had any information on the use of Medication Therapy Management (MTM) as a way to reduce healthcare cost and prevent, or decrease, readmissions.

    I’m kind of a digital packrat and I knew that I had some stuff sitting in Evernote, so I spent the better part of a day rummaging through the information I had. The deeper I dug the more I realized that MTM is a no-brainer. There’s enough information out there to convince even the staunchest opposition.

    Some thoughts I had as I read through my Evernote notes:

    1. I find it interesting that we’ve coined the phrase Medication Therapy Management (MTM) for something that pharmacists have been doing for decades. I remember interning for a community pharmacy back in the late 90’s. Speaking to the patient about their medication, adherence, compliance, adverse effects, etc was simply part of the job. Have we forgotten about that?
    2. MTM comes in many forms. Positive intervention can be achieved over the phone, via Telepharmacy, face-to-face with a pharmacist or technician, and so on. It is not a one size fits all approach.
    3. Even the simplest interaction between provider and patient can create a positive impact.
    4. MTM should start when a patient is admitted for any condition, continue throughout their hospital stay, and follow the patient out the door to their homes. In other words it should be continuous.
    5. Not everyone will need pharmacist intervention once they leave the hospital. Healthcare systems should first target patients with chronic conditions, problems with cognition, poor history of compliance, or a heavy medication burdens. Like everything else in the world around us, some people will do better with more help while others will prefer less.
    6. mHealth and sensors should be part of MTM. Continuous glucose monitoring, heart monitors, blood pressure sensors, smart bottles, devices to monitor and record inhaler use – classic area for pharmacist intervention, wireless digital scales for weight – think heart failure, and so on . This information should be fed directly into the patients MTM record for review by the pharmacist, physician and nurse.

    Below is a summary of the MTM information I sent my colleague.
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  • Using facial recognition for medication adherence?

    While doing a routine search of Twitter I came across AiCure (@AiCureTech), which touts itself as “Computer vision and facial recognition technology to confirm medication adherence on mobile devices”. Ok, you got my attention. Unfortunately the Twitter account appears to be dead as the last Tweet listed on the account was from September 25, 2013. The AiCure website is a bit more recent, however. The last item posted to their News & Events section was from March of this year.

    There’s a video on the website that gives a basic overview of the process. I would have embedded the video here, but couldn’t figure out how to grab it, which is a real shame because it’s in their best interest to make information easy to share.

    After watching the video I’m not entirely sure that the process makes sense to me. The video shows a jogger running on a pier. The jogger receives a notification on her smartphone reminding her to take her medicine. She stops, pops the tablet in her mouth, records the transaction via facial recognition on her smartphone, and then merrily continues on her way. In my experience people that are as “with it” as the person portrayed in the video don’t have any trouble remembering to take their meds; calendar reminders, pill bottle next to the coffee pot, etc. And why is the jogger carrying her medication with her while out jogging? I assume her jogging session wouldn’t last more than an hour or two. Take the med before or after. There’s no sense of the importance of the medication to the patient’s condition, nor is their any sense of the person being so busy that they couldn’t remember to take their medication. It would have made more sense to show some teenager with a serious medication-dependent disease state going through a busy school day. Right? Having so much fun with their friends that they forget to take their medication?

    Thoughts on marketing aside, the concept of using facial recognition is intriguing.

    From the AiCure website:

    The combination of automated computer vision technology with dynamic patient feedback, offers a new gold standard in medication adherence monitoring. The computer vision platform is being extended to develop a robust identification and authentication system for medication.

    Much like a voice recognition system, which understands what the user says, AiCure’s sophisticated, patented computer vision system visually understands what the user is doing.

    The software-based technology is uploaded onto a smartphone or tablet computer. The user follows a series of pre-determined steps that are instantly recognized and confirmed through the webcam.

    Automated DOT® [Directly Observed Therapy] confirms facial identity, medication dosage, correct ingestion, and time of ingestion. In addition, built-in data tools allow for ongoing patient-provider feedback; reminders in case of nonadherence; positive feedback; self-reported data by the patient; and therapy information – all designed to ensure real-time adherence monitoring and improved patient adherence over time.

  • New Medscape Pill Identifier Tool [reference]

    Medscape Pill IdentifierI received an email this morning from Medscape introducing me to their new Pill Identifier Tool.

    The tool is pretty simple to use. When you click on the link above you’ll be taken to the Pill Identifier Tool site where you can begin your search. Any pharmacist, nurse, or physician that’s ever used a reference to identify an oral medication will be familiar with the process.

    Across the top of the Pill Identifier you will find several fields to help narrow your search: IMPRINT, SHAPE, COLOR, FORM, SCORING. I’ve always found that if you have the imprint you’re about 80% there.

    Clicking on a medication will give you additional information. There’s even an option to view the Drug Monograph.
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  • New Questions for Pharmacists in the Health Care System [article]

    Am J Pharm Educ. 2014;78(2)1: “The pharmacy profession is determining how it will become a vital part of new health care models such as accountable care organizations (ACOs) and patient-centered medical homes (PCMHs). Pharmacists must be prepared to demonstrate their value in these emerging health care models by improving the quality of care, reducing health care costs, and enhancing patient access and satisfaction. The health care decision makers will require demonstration of value, framed in business language, using new measures of outcomes quite different from what have been used in the past for pharmacy services. Colleges and schools of pharmacy should take on the task of developing these new measures demonstrating pharmacist value in collaborative care delivery, and instruct students in how they will need to demonstrate their value in new health care models.”

    Interesting view from the authors. I’m not opposed to calling for colleges of pharmacy to develop measures to determine the value of pharmacists, but I would caution those developing these measures to learn from others. Physicians defined their measures and outcomes long ago and are paying for it dearly now. Pharmacists should not seek to mimic such a model, i.e. valued on the number of interactions, patients seen, and billable events.

    The time for proving that pharmacists can actively participate in patient care is past. The data is there, but the profession continues to think that providing even more data will flip a switch that will instantly make pharmacists a valued member of the healthcare team. That’s not likely to happen, even in the data-driven healthcare environment of today. Pharmacists are viewed quite differently from physicians and other direct patient care providers like nurse practitioners, and rightly so. As pharmacists continue to fight for “provider status” they should consider carefully the end goal of such a fight.

    Let’s not forget what pharmacy is all about. Pharmacy is about providing the safest, most effective, cost conscious therapy possible. That doesn’t necessarily equate to “provider status”.  What happens when the primary concern of our profession is no longer pharmaceutical care? Who will provide such expertise when pharmacists no longer concern themselves with such things? I do not recommend living in the past, but I do recommend thinking long and hard about the future of the profession.

    Go read the entire article, it’s only a few paragraphs long. I’d love to hear your thoughts.

    —————–

    1. Joseph T. DiPiro and Robert E. Davis (2014). New Questions for Pharmacists in the Health Care System. American Journal of Pharmaceutical Education: Volume 78, Issue 2, Article 26. doi: 10.5688/ajpe78226

  • Proposed USP Chapter <800> for Hazardous Drugs

    The rules and regulations swirling around acute care pharmacy clean rooms continues to grow. Recently I became aware of the United States Pharmacopeia and The National Formulary (USP–NF) General Chapter <800> Hazardous Drugs—Handling in Healthcare Settings, or simply USP <800>. I attended a webinar put on by Pharmacy Advisor that specifically addressed USP <797>, but briefly mentioned USP <800>. Then a colleague and friend mentioned it so I decided I better learn a little bit more about the proposed chapter.
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  • Cool Pharmacy Technology – WillCall Rx from SencorpWhite

    I had an interesting call with an account executive from SencorpWhite last week. He and I talked about several things, but one thing I found particularly interesting is something the company is doing in the outpatient pharmacy space with horizontal carousels. Carousels are neat technology for those that have a need for automated storage space, i.e. you’re “space challenged” in your pharmacy. When coupled with bar-code scanning technology carousels are a good way to manage all kinds of inventory in a pharmacy.

    The system from SencorpWhite is referred to as WillCall Rx and consists of several components designed to store and retrieve prescription items that have been filled and are ready for patient pickup. I’m familiar with the WillCall Rx system and have had the pleasure of seeing it up close and personal in two large outpatient pharmacies attached to large medical centers. It’s a neat concept.
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  • RFID vs barcode technologies

    MedKeeper: “Based on similar use cases, the comparison between bar code and RFID technologies is inevitable. Several papers have reviewed the use of these technologies in hopes of defining best practice. Young concluded that a coordinated use of these technologies might provide the best compromise between implementation costs and potential benefits.   RFID technology, with its high cost, may be most appropriate for patient identification, while the lower cost of bar code systems may be more appropriate for material inventory.[3]

    Sun et al.[4] arrived at a similar conclusion. In this case, the authors evaluated medication error reduction. Due to the high cost of RFID tags and readers the authors proposed a system utilizing less costly bar codes for unit-dose medications while using an RFID-embedded wristband worn by patients for identification.”
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  • Using Google Glass in the pharmacy [youtube video from Drug Topics]

    “Barry Bryant is owner of Barney’s Pharmacy in Augusta, Ga. He and his clinical pharmacy educator, Jake Galdo, discuss some of the ways this new technology can be used in the pharmacy.”

    It was bound to happen eventually. Someone in pharmacy finally decided to play with Google Glass. Nothing too specific, apparently just tossing around some ideas, but nice to see. I hope these guys continue to post their experience with glass.

    The HIPAA comment cracks me up. The comments about Glass being a HIPAA issue are nonsensical because the same concerns apply to any photo taken with any camera, whether it’s from Glass, a phone, a security camera, and so on. People fretting over the concept of taking a photo of someone is crazy. With that said I’ve come to expect comments like this.

  • UCSF and Walgreens “reimagining pharmacy care”. Yeah, not so much…

    baby_cryingUCSF: “A new initiative by UC San Francisco and Walgreens seeks to turn those numbers around, starting at the neighborhood pharmacy….“Walgreens at UCSF” is a pilot store that offers the most advanced level of community pharmacy care available in the United States today. It starts with the store’s unusual layout: Walk inside and the first thing you see isn’t racks of cosmetics or greeting cards; instead there’s a concierge desk where you can arrange a private consultation with a pharmacist or find out whether your prescription is ready. Pharmacists work with every customer to make sure they understand the medication they’re picking up, while also offering services such as the medication management that brought Helen to UCSF… For UCSF, it will serve as a teaching ground for student pharmacists completing their doctoral degree program, a clinical training site for pharmacy residents, and a research facility that explores new pharmacy patient-care models and programs.”

    I found myself at UCSF Medical Center earlier this week and decided to visit the new Walgreens. I had previously read about the setup on Twitter and a couple of articles I found online.

    Here are my thoughts and experiences regarding the “Wallgreens at UCSF”.
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