Jerry Fahrni

Category: Pharmacy Practice

  • Quick Hit: Thoughts on NEPS labeling solution for pharmacy

    I wrote about the NEPS labeling solution for pharmacy way back in May of 2009. The product basically extends the functionality of the pharmacy information system by giving users the ability to print custom labels for medications through the use of different fonts, colors, and images. It’s well thought of in certain pharmacy circles. In the hands of the right people NEPS can be an effective way to create some pretty cool labels. In the hands of others it’s a good way to create confusion.
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  • Homegrown medication tracking at Children’s Hospital Boston

    Children’s Hospital Boston is a 395-bed children’s hospital located in the Longwood Medical Center area of Boston Massachusetts. It’s a pretty cool place near Harvard School of Medicine as well as the Massachusetts College of Pharmacy and Health Sciences; not to mention that it’s literally right across the street from the famous Brigham and Women’s Hospital.

    I’ve had the pleasure of visiting Children’s Hospital and receiving a grand tour of the pharmacy and all its operations. The Pharmacy Director and IT Pharmacist have a great vision for what can be accomplished with the appropriate use of pharmacy automation and technology. They’re both quite practical about their decisions in this area.

    The pharmacy itself makes great use of technology like the Cerner Pharmacy Information System, carousels, high-speed automated packagers, DoseEdge IV Workflow Management system, as well as a homegrown medication tracking system, which I found fascinating. The medication tracking system has been in use for some time now. Children’s built the system themselves, which makes it all the more impressive. You just don’t see that kind of thing these days.

    The Director of Pharmacy at Children’s Hospital Boston provided me with a link to the YouTube video below. The video shows the nuts and bolts of their medication tracking system. While not detailed, it’ll give you a general idea of what it does.

  • Getting creative with pharmacy labels: dosing calculations

    I was searching for inpatient pharmacy label examples, specifically IV label examples, for a project that I’m working on and came across a site called RxLabelToolkit.com. It’s a neat little site that offers quite a bit of information on label design. I don’t know if the business is still active as the most recent post I can find on their blog is from December, but it’s worth a few minutes of your time to stop and have a look.

    RxLabelToolkit.com: “One of the most valuable features of BarTender for pharmacy, is the ability to perform pharmaceutical calculations right within the label application. This allows us to build a label that can calculate a dose, an infusion rate, expiration date or a taper schedule. Any mathematical formula needed can be performed right in the label application.”

    The site has some pretty cool examples. The ampicillin label below is my favorite. There’s also a brief slide presentation that walks you through all the fields on the example label.

    Ampicillin1gmLabel

     

  • The future of 340B, my perspective

    The snippets below are taken from a recent article in Pharmacy Times: The Future of 340B: It’s All About Perspective

    “Established more than 20 years ago [the 340B Drug Discount Program], this legislation was enacted to assist different health care settings in providing excellent care for indigent and vulnerable patients. To allow this to happen, safety net providers have access to discounted outpatient drugs from manufacturers. By being able to purchase the discounted medications, these qualifying organizations are able to utilize the savings to provide care for those uninsured and underinsured patients. “ – The 340B Drug Discount Program can be a great thing for healthcare systems that care for a lot of ‘uninsured’ or ‘underinsured’ patients. These are often time indigent patients.
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  • Please take this short online pharmacokinetics survey (5 minutes)

    Several years ago my brother and I designed and developed RxCalc, a pharmacokinetics calculator for the iPhone and iPod Touch. It has been several years since we’ve updated the application, but we’re hoping to change that.

    Below is a short survey that will help us determine what features and functions healthcare professionals would like to see in their pharmacokinetics application. The survey is short, but will provide us with important information. Please take a few minutes to complete the survey and submit your response.

    jerry_sig

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  • What’s the single most important technology introduced into pharmacy operations in last 10 years?

    I asked this question on Twitter today looking for opinions from the countless number of people roaming the internet. Alas, I received not a single response. Not one. I’m starting to think that Twitter, and most other social media, is worthless as a way of gathering information from people. Oh sure, my Twitter feed is great for consuming an endless string of articles and links, but the few times I’ve actually reached out to the Twittersphere with a question I’ve ended up with bupkis.
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  • Motion sensing technology in the IV room

    I’ve always been intrigued by motion sensing technology like Microsoft’s Kinect for the Xbox system. My interest was rekindled last week when I came across an article at Fast Company taking about Kinect Hacks.  I do what I always do when I read something interesting, I Tweet about it.

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  • Crowdsourcing pharmacokinetic data

    RxCalcPharmacokinetics is something that every hospital pharmacist is intimately familiar with. It just so happens to be one of the things that physicians routinely ask pharmacist to handle. It’s not that doing pharmacokinetic (PK) calculations is difficult, but crunching the numbers can be time consuming and there are occasional traps that can lead to problems for those not experienced in such things.

    I’ve performed literally thousands of PK calculations* during my career. When I first began practicing pharmacy there were lots of drugs that required pharmacokinetic monitoring: lidocaine, procainamide, vancomycin, the aminoglycosides, phenytoin, digoxin, phenobarbital, among others. Over the years many of these drugs have been replaced by newer, better agents or simply fallen out of favor.

    Some PK calculations can be harder than others, like phenytoin because of its reliance on Michaelis-Menten parameters, or lidocaine because it required loading doses due to its multi-compartment distribution. But others are brain-dead simple. Vancomycin is like that. A monkey could do a new vancomycin start.

    During those years one thing remained constant; to perform PK calculations all you needed was a pencil and a calculator. Things have changed over the years with the increased use of computerized software and mobile devices, but the nuts and bolts of the process remains the same.

    With the advent of big data one has to wonder why pharmacists continue to do this. Is it a matter of tradition that keeps us tied to pharmacokinetics? It’s hard to say. I remember looking at population trends when I was working as a critical care pharmacist nearly ten years ago. Another pharmacist, Patrick and I kept a spreadsheet of patient ages, gender, height, weight, renal function, infection site, infectious organism(s), and of course drug levels. We were attempting to use our data to find trends that would help us initiate therapy more accurately. Our project never really panned out. We discovered very little in the year we collected the information. The reason for our failure was lack of data and our inability to rigorously study the information in front of us. That’s no longer the case. Given the opportunity, data scientists could analyze hundreds of thousands of PK starts and adjustments to uncover things that Patrick and I could have only dreamt of a decade ago.

    So one has to ask whether or not this is being done today, and if not why?

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    *conservatively I see it as follows:
    10 years as a “clinical pharmacist”
    50 weeks per year working (hey, everyone needs a vacation)
    average of 6-10 new PK starts per day; twice that number of monitoring
    taking the low road: 10 x 50 x 6 = 3000

  • Pharmacist remote order verification, i.e. checking something from afar

    The current pharmacy practice model utilizes pharmacists to check everything that leaves the pharmacy. Right or wrong that’s the way it is. I don’t think it’s necessary, but I’m not the guy in charge of such things.

    Pharmacy has tools to help get pharmacists out of the physical pharmacy, namely tech-check-tech and remote order verification, but I don’t see such things used with consistency. My position on tech-check-tech is well documented; it’s underutilized. Using technicians “at the top of their license” would go a long way in freeing up pharmacists to do other things. The problem at the moment is that many pharmacists don’t want to relinquish the “final check” responsibilities. It’s silly, but true.
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  • Stanford University Medical Center Pharmacy site visit [07 31 2013]

    I just rolled in the door from Palo Alto, where I spent most of the morning visiting the Stanford University Medical Center inpatient pharmacy. And why not, I didn’t have anything else to do today. I picked up the phone, connected with the Director of Pharmacy, Mike Brown and was on my way.

    First and foremost, the inpatient pharmacy at Stanford is nice. It’s also quiet, which is a bit unusual for a pharmacy servicing such a large facility. Interestingly enough most of the non-IV related medication distribution is handled with the use of very little automation; there’s an interesting story to go along with that.

    The pharmacy at Stanford has a large investigation drug service (IDS) area, which is responsible for handling approximately 300 active drug trials at the moment. Impressive. They use IDS management software called Vestigo integrated with Epic to manage everything. It’s pretty slick.

    My reason for the visit wasn’t for the non-IV medication distribution or IDS, however. What I really wanted to see was their IV room, and the associated distribution process. I’d heard through the grapevine that they were using a product called Phocus Rx to manage their chemotherapy preparation. I wrote about Phocus Rx in March of 2012. I’ve heard a lot about the system over the past year, but had yet to see it action.

    The IV room didn’t disappoint, it was great. They let me change into scrubs, gown up and spend about 90 minutes in the cleanroom watching the pharmacist and technicians run through the process. It’s been a long time since I’ve done anything like that. It felt good. There was something right about it.

    As far as Phocus Rx goes, in my mind it’s basically a less feature-rich version of DoseEdge (post Feb 2010). Both systems use cameras and software to manage workflow, but that’s about where the similarities end. Phocus Rx uses a different camera setup than DoseEdge, i.e. the camera is located outside the hood versus inside the hood, respectively. The other differences include how information is sent to the IV workflow system, different approaches to barcode scanning, inclusion/exclusion of clinical decision support tools, and their inclusion/exclusion of gravimetric analysis for dose verification. Phocus Rx is “considerably less expensive” than DoseEdge, although the exact dollar figures remain a mystery. Which one is better? Impossible to say. That question is completely subjective and depends on your needs.

    The visit was interesting, and eye opening. The pharmacy personnel in the cleanroom were courteous, professional, and quite knowledgeable about the system. It was impressive to watch. I also learned a lot, which I will now add to my ever expanding personal database of IV room technology.