Jerry Fahrni

Category: Pharmacy Practice

  • PillPack: a new way of thinking about an old problem

    I read a Wall Street Journal article this morning about an online pharmacy called PillPack that’s doing something a little different. “PillPack mails its customers their medications every two weeks, but rather than putting them into several big bottles, the company pre-sorts them into sealed, single-dose packs, based on when a patient needs to take their medications throughout the day. The pills arrive in a long chain of dose packs, linked together on a recyclable dispenser roll.”

    It’s not a new concept at all. In fact, the idea has been tossed around in certain pharmacy circles for years. Many companies are capable of providing such a service, but most lack the vision to bring the concept to life. Perhaps PillPack can provide enough value to its customers to make it viable. I really hope it works out for the company. At least they’re thinking outside the box, er, inside the box.

    PillPack should really think about partnering with local hospitals and deliver discharge meds to the patient bedside in this handy format. Counsel the patient, make sure they have their meds, automatically enroll them in the mail order service, and so on. Just sayin’.

  • Pharmacy system integration appears to be on everyone’s mind

    I’ve noticed an interesting trend recently. Healthcare systems, and more specifically pharmacies, have started to understand the importance of having integrated systems. I realize that the concept of having various systems talk to one another isn’t new, but you’d be surprised at how poorly disparate systems within the pharmacy communicate. Automated packager from company “A”, medication tracking system from company “B”, inventory management from company “C”, and so on. These systems rarely utilize a single master database of information, instead relying on frequent manual updates to multiple databases. The result of such a system is often inaccurate information if you’re lucky, or outright errors if you’re not.

    integration
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  • Worst IT pharmacist recruitment attempt ever?

    I haven’t heard from a headhunter in a long time. I get blasted with useless stuff from LinkedIn on occasion, but no laser targeted attempts. But without a doubt what I’m about to show you takes the cake.

    The information below landed on my website in the comment section of this post. Read it carefully and then explain to me what part of the job described requires an IT pharmacist.
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  • Automated Medication Preparation for Chemotherapy [PP&P December 2013]

    The December 2013 issue Pharmacy Purchasing & Products features a Q&A session with Anne McDonnell, PharmD, BCOP; Caryn Belisle, RPh; and Josephine Leung, PharmD, MBA from Brigham and Women’s Hospital, Department of Pharmacy

    I had the opportunity to visit Brigham and Women’s Hospital earlier this year while doing some research for a project I’m working on. It’s a very interesting facility that makes use of a lot of pharmacy automation and technology. Based on what you read below you’d think that everything was perfect. What I saw was interesting, but far from perfection.

    Worth noting in the Q&A session is that the products being used are never defined, i.e. what technology is being used. There’s mention of a robot, but which robot? They speak of gravimetic analysis, but don’t say what system they’re referring to. I know because I’ve been there, but other people might like to know as well don’t you think?

    Here are some of the questions and responses I found particularly interesting in the PP&P article.
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  • California State Board master formula and sterile compounding logs

    I’ve been looking through a lot of the California State Board of Pharmacy requirements for sterile compounding logs and accompanying master formula records. The information can be found in the California Lawbook for Pharmacy 2013 [PDF], specifically California Code of Regulation (CCR), Article 4.5 Compounding.
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  • #CareFusion jumps into the IV room with new Pyxis IV system

    You can add another player to already crowded IV workflow management system space.

    I heard a rumor that CareFusion had some new technology in their booth at ASHP Midyear this year. Since I’m at ASHP Midyear I decided to wonder over there to take a look, and lo and behold they did indeed have some new stuff. One of the things that caught my eye was their new IV room system.

    The system is like many that I’ve seen, complete with camera and barcode scanning for IV medication preparation. I didn’t have much time to evaluate the system, and it’s virtually impossible to do so in the span of a short demo, but overall the Pyxis IV system hits all the major safety checkpoints for this kind of stuff.

    CareFusion is playing things pretty smart by moving into the IV room. They’re taking a broad approach to managing the entire inpatient pharmacy, i.e. they now have products that cover medication distribution from back door to the patient, including both IV and non-IV medications. Well played.

    So what’s the over-under on how long it will take Omnicell to build or buy an IV room system?

    From the CareFusion newsroom:

    While the greatest percentage of a hospital pharmacy budget is the cost of IV medication, it is estimated that fewer than 10 percent of hospitals use automation within their IV room where infused medication is compounded. The new Pyxis IV system* helps standardize the workflow in the central pharmacy IV room to securely manage a closed-loop pick, prep and check process, while driving efficiency in pharmacy activities. This standardization also helps improve the accuracy and error rate reduction of the IV compounding process, as well as free up pharmacy staff to redeploy to clinical activities. The new Pyxis IV system consists of monitors in the IV room that walk clinicians through each compounding step. The system organizes all similar orders and recommends the proper vial size to use when compounding to help minimize waste. The system also has video cameras to record compounding components to help facilitate remote checking by a pharmacist, which saves time by eliminating the need for clean room entrance and exit processes

  • Thoughts on implementing #DoseEdge in an acute care pharmacy

    Over the past twelve months or so DoseEdge has become the most popular IV Room Workflow Management System on the market. Why I cannot say, but my guess would be a combination of timing – the NECC tragedy – and name recognition. If you were to ask acute care pharmacy IT folks about IV Room Workflow Management Systems I doubt many of them could name more than one or two, and of those that could, I assure you one of their answers would be DoseEdge. Pharmacy is a small world and word of mouth carries tremendous weight, and DoseEdge clearly has the advantage in that respect.

    DoseEdge System at Boston Children's Hospital
    DoseEdge System at Boston Children’s Hospital

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  • Weighing in on gravimetrics

    I’ve been doing a lot of research lately on i.v. workflow management system. In fact, I’ve been able to spend time observing several of these systems in operation in real healthcare facilities. If you really want to see how something works in a pharmacy spend some time watching a technician work and talking to them about it. You can only learn so much from marketing material, which is, shall we say, less than completely forthcoming with information.

    Each system I’ve reviewed has fundamentally the same concept, but different approaches. One of the most distinct differences I’ve encountered is the inclusion or exclusion of gravimetric analysis during the i.v. compounding process. Some have it, some don’t.
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  • Quick Hit: The unspoken contributor to drug shortages, strategic overstock

    The other day I discovered a new term being thrown around in pharmacy circles, and that term is “strategic overstock”. The best way to describe strategic overstock is to call it what it is, i.e. hoarding. Of course healthcare systems don’t want you to call it hoarding because that would be considered inappropriate so they created a term that makes people think they’re doing something positive; marketing spin, if you will.

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  • What are you looking for in a “workflow management system” for the IV room?

    A recent “I’ve been thinking…” by Mark Neuenschwander got me thinking; no pun intended. Mark and I have been working on a barcode medication preparation (BCMP) project for the last couple of months. My interest in pharmacy automation and technology coupled with his passion for barcoding in healthcare and patient safety have created a good working relationship. We’re currently looking at the state of BCMP as it relates to compounding in the IV room.
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