Remington’s is an interesting pharmacy reference. It’s on my list of must-have reference books because it has always had a bit of information that you can’t find elsewhere. This is especially true in older editions which contained great information on extemporaneous compounding and manufacturing. I used to collect old Remington’s. Hey, everyone needs a hobby.
You can check out a sample chapter here.
Medication adherence/compliance is an important issue for all patients with chronic disease, but some are potentially worth more in healthcare dollars than others. Disease states like diabetes, heart failure, asthma and HIV/AIDS, among others rely heavily on proper medication use to prevent frequent visits to urgent care centers, or in worst case scenarios hospital admissions. It’s not hard to imagine where reducing urgent care visits and hospitalizations could add up quickly.
Medication adherence/compliance is also one of those areas where it makes sense for pharmacists to be heavily involved. A little proactive counseling, MTM and follow-up with patients goes a long way. The abstract below makes no mention of pharmacists, nor does it mention how they mined their data. If I had to guess I’d say they used insurance claims data to get their information. Not the most accurate way to go about it, but interesting nonetheless.
From a recent article in August 2012 issue of Pharmacy Practice News:
Within the first month of implementation [of a bar-code medication preparation (BCMP) system], 85% of all IV drugs in the children’s hospital IV room were covered by the BCMP system, which does the following: “prints†labels to a touchscreen computer from which a technician can pick which dose he or she wants to prepare; verifies via bar-code technology that the correct medication and diluent were chosen, provides instructions to technicians about how make the preparation, allows technicians to take pictures of the preparation process and automatically time stamps each step in that process for future record keeping and management reporting.
The unique bar code that is assigned to each product then can be used to track the medication to the nursing unit, or whatever end location has been provided, with a location bar code.
Since the implementation of the BCMP IV system, which both Drs. Fortier and Maughan describe as a “best practice for the near future,†MUSC staff have seen “eight to 10 medications a day that could have been an error [with] the old system,†according to Dr. Maughan. “That represents 1.3% to 3% of the total number of doses dispensed.â€
It’s no secret that I think the IV room is an area that pharmacy has yet to address properly when it comes to automation and technology. We simple haven’t developed a product that will change the way pharmacy compounds IV’s. I have some thoughts on that, but will keep them offline for now. If you’re interested in talking about the future of IV room practice feel free to drop me a line. Sorry, I digress.
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I wrote about the change in CMS policy regarding single-dose vials a few weeks ago. It looks like I may not be the only one that’s interested in the topic. Pharmacy OneSource is offering a webinar on August 8 titled “Maximizing the Use of Single-Dose Vials“. The speaker is Eric Kastango. Eric is one of, if not the, foremost authorities on all things pharmacy cleanroom and USP <797>. He knows his stuff. I had the pleasure of hearing Eric speak at the ASHP Midyear in Anaheim in 2010.
There’s no cost to attend the webinar, so do yourself a favor if you have any interest in the topic and register. I was planning to attend, but have a scheduling conflict. I’ll have to grab the slides later.
You can register here.
I’ve been an ASHP member off and on for much of my career. I’m not much for membership in organizations, but I thought ASHP would be worthy. Heck, they’re the biggest professional pharmacy organization in the country (world?), why wouldn’t I be a member.
I try to give them the benefit of the doubt, but sometimes I wonder who’s driving the bus. I believe ASHP’s goals should be to: 1) promote the profession, 2) improve the profession, 3) defend the profession from nefarious sorts, , and 4) offer guidance to help move the profession into the future. That’s it. Read into it what you will, but pharmacists and technicians pay to be members of ASHP. Why? Because they believe ASHP will make pharmacy better. Otherwise there’s no point.
I’ve dabbled in some of the small groups within AHSP, specifically the Section of Pharmacy Informatics and Technology (SOPIT). These small groups focus on specific issues within the profession. Their purpose is to come up with solutions and recommendations. And in the case of the SOPIT the goal is to help solve problems associated with pharmacy informatics, automation and technology within the practice of pharmacy. It’s actually a good group that has done some great things over the years.
One of these groups in particular had great promise as it brought together several companies in the industry to look at the problem associated with informational standards; particularly drug information updates to pharmacy formularies. One of the problems with information within formularies (drug dictionaries, drug masters, <insert other name here>) is that standards simply don’t exist. Everyone has their own way of doing it, which causes problems.
While serving as the IT pharmacist at my last facility I had to manually maintain several formularies: pharmacy information system, ADC’s, pharmacy inventory management system, barcode labeling system, online hospital formulary, etc. It was time consuming and fraught with error. And before you ask, yes I made mistakes in those systems that caused problems; problems that were a bear to fix.
The group mentioned above was brought together to look at this problem and propose a method for companies to collaborate with the sole purpose of bringing a single standard to the practice that could be utilized to populate hospital formularies in a “downhill†fashion, i.e. one formulary update delivered to a centralized location that could be pushed out to other formularies. One standard. One location to update. One  formulary to monitor. One formulary to maintain. Simple. Fewer errors. Less work. Better for the profession.
Unfortunately AHSP decided to kill the project. I’m greatly disappointed in ASHP for doing this.
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Ann Intern Med. 3 July 2012;157(1):1-10
A study looking at pharmacist-assited med rec, counseling and telephone follow-up after dischage for adults hospitalized with acute coronary syndromes or acute decompensated heart failure. According to the article pharmacist intervention didn’t do much in the way of reducing “clinically important medication errors“, but may have led to fewer potential ADEs.
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I put this up the other day at my Talyst blog. I don’t often cross post between that blog and this one because I tend to keep the “corporate” blog a bit more watered down. But in this case I thought it was worth it. I’ve been thinking a lot about the use of color in pharmacy labels. I’m not sure why we don’t see more of it in pharmacy. It may have something to do with the limited number of suitable color printers and label stock. As prevalent as color printing is in the consumer world, you’d think it would be simple. Unfortunately it’s not.
I for one think color has a place in the pharmacy. It could be used to improve patient safety, and when used appropriately improve workflow and operations.
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Each Friday I receive a newsletter from CompoundingToday.com. The newsletter features an editorial from Dr. Loyd V. Allen, Jr, Editor-in-Chief of the International Journal of Pharmaceutical Compounding.
A couple of weeks ago the editorial focused on the Centers for Medicare and Medicaid Services (CMS) newly clarified position on the use of sing-dose vials in medication distribution. It’s a rather important piece of information that I haven’t seen elsewhere. You’d think hospitals would be jumping all over this as it not only saves waste, i.e. cost, but can help with the drug shortage issue as well. It’s hard to say why I haven’t heard more about it, but I haven’t. Go figure.
Anyway, Dr. Allen’s editorial is reproduced in its entirety below. The CMS document can be found here (PDF).
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An article in the American Journal of Pharmaceutical Education takes a look at “the nature and extent of medication adherence education in US colleges and schools of pharmacyâ€. Surprise, the authors found that “Intermediate and advanced concepts in medication adherence, such as conducting interventions, are not adequately covered in pharmacy curriculumsâ€. Disappointing outcome as medication adherence is one of those areas where I think pharmacists could make a significant impact in not only healthcare outcomes, but reducing costs associated with patient care as well.
The authors used a combination of surveys to gather information: “(1) a national Web-based survey of faculty members at colleges and schools of pharmacy, (2) a national Web-based survey of student chapters of 2 national pharmacy organizations, Phi Delta Chi (PDC) and the National Community Pharmacists Association (NCPA), and (3) conference calls with a convenience sample of pharmacy preceptors and faculty members.† While the study isn’t exactly comprehensive, I think it may be representative of what’s really going on in pharmacy schools these days. Let’s face it, the focus is on “clinical” activities of which medication adherence is often overlooked.
I won’t bore you with the details as the full text of the article is available for free at the journal’s website. What I will say is that it appears that pharmacy schools teach medication adherence, but fail to dig deep enough or allow students to participate in a meaningful manner when given an opportunity to become involved. This is similar to my experience in pharmacy school. The only place I was really exposed to medication adherence was during a six week internal med rotation. Other than that the subject was only covered in passing.
[cite]10.5688/ajpe76579[/cite]
With the ubiquity of smartphones and tablets these days it seems that pharmacy would finally come out of the dark ages and start using these tools to their benefit. I recently read an article at MEDCITY | News  that talked about the use of tablet technology for “teleroundsâ€.
Telerounds: The sexy idea is about providing a way for patients in a hospital setting to communicate with their physicians even when they are not at the hospital. An early version of the concept in 2005 took the form of physician robots on account of the tablet screens being attached to “robots†that move from patient to patient. A study conducted by Johns Hopkins researchers in 2005 met with positive feedback from patients and the Henry Ford Hospital in Michigan has been testing the concept with patients using iPads equipped with a Apple’s Face Time program, similar to Skype, in post surgery settings. On industry expert rattled off several reasons why it just isn’t practical right now. First, it would assume that surgeons are always available when the patient needs to speak to them. Current reimbursement models don’t support it. Most hospitals don’t grow iPads on trees for patients to use upon admission. It wouldn’t work with physicians since they could not be reimbursed. Still, it might work better when patients are discharged as a solution for providers trying to reduce readmission rates.