Jerry Fahrni

Category: Pharmacy Practice

  • I have seen the end of operational pharmacists in long term care (#LTC)

    I spent Saturday, Sunday and Monday in Baltimore, MD at the ASHP Summer Meeting (#ashpsm). I was there for work, and didn’t have an opportunity to participate in any of the sessions. I did however get the opportunity to visit a large long term care pharmacy called Remedi SeniorCare just outside the city. This particular pharmacy is using Paxit robots to handle the dispensing needs for well over 10,000 long term care beds throughout the area.

    I am not a fan of robots in general, but I couldn’t help but be impressed with Paxit. The design is groundbreaking, genius and game changing for long-term care pharmacists. My initial impressions were’t exactly flattering, but after watching it run for the better part of an hour, and listening to the owner talk about it, my opinion changed.

    During part of the conversation our tour guide said that the company was able to “lay off five pharmacists” after getting the Paxit machines up and running. My gut reaction was one of anger. Who the heck do they think they are to get rid of pharmacists in a pharmacy! After all, I’m a pharmacist and no machine can replace me. Right? Wrong. Paxit does a fine job of replacing pharmacists in their traditional dispensing role. And it doesn’t make mistakes, it doesn’t get tired, it doesn’t whine about working conditions, it doesn’t show up late or call in sick, it doesn’t need benefits, etc, etc. No, the Paxit robot makes perfect sense in this environment both from a business standpoint as well as a safety standpoint; they’ve been filling prescriptions with Paxit for three years and it hasn’t committed a single dispensing error. I wish I had had such a safety record when I was still a real pharmacist.

    After my initial reaction I realized that the fault lies with ourselves, i.e. pharmacy practice itself. It’s our own fault. We’ve created a system where we can be replaced by a machine under the right circumstances. Anyone that’s been in pharmacy for any length of time could have told you this was coming, but we haven’t done anything to stop it. And by stop it I mean change our practice. I worked in an LTC pharmacy for nearly two years. It’s brain-numbing work. There’s very little need for a highly trained clinician in an LTC pharmacy. You certainly don’t need a highly trained clinician to check bingo cards or make sure all the right pills are in a med drawer. If you think you do, then you’re wrong. Dead wrong.

    Listen up all you pharmacists stuck behind the counter in retail pharmacies or sitting in the “main pharmacy” in a hospital dutifully counting meds as they go out the door. Continuing down the current path of pharmacy distribution is like putting a gun to the head of your pharmacy career. It’s only a matter of time before you’re obsolete, and it won’t be anyone’s fault but your own. It won’t matter for me as the change is probably still 20 years away, but for those of you just starting a new career “in pharmacy”, you should be looking over your shoulder.

  • Clearinghouse for pharmacy automation and technology ideas

    My post from last week along with a conversation I had with my brother got me thinking about all the good pharmacy ideas that never see the light of day. I know there are some great ideas out there because I’ve been fortunate enough to see many of them in my travels. My job gives me the opportunity to visit a lot of hospital pharmacies and speak to a lot of pharmacists and pharmacy technicians. Trust me when I say there are a lot of smart people out there that could improve the practice of pharmacy with their ideas.

    So why is it that so many good ideas don’t get the attention they deserve? There are lots of reasons.
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  • Should healthcare systems offer incentives to improve med adherence?

    I saw the article below over the weekend and wasn’t sure how I felt about it. On one hand it’s a good thing for people to adhere to their medication regimens. Medication adherence ultimately leads to lower overall healthcare costs secondary to fewer hospital admissions, fewer lost days to chronic disease “flare-ups”, fewer re-treatments or extended antibiotic courses, and so on. When you think about it like that, it makes sense. On the other hand, you’re telling people that there are no consequences for their own bad behavior. Hey, if you don’t take your medication that’s ok. We’ll give you money each time you do to “encourage you” to do it.

    According to the article “cross-study comparisons indicate a positive relationship between the value of the incentive and the impact of the intervention“. So, the more “incentive” I give you the more likely you are to take your medication. Not surprising.

    What ever happened to just being a good citizen and doing the right thing? Civic responsibility?

  • Pharmacy student adherence to a simulated medication regimen

    A Tweet from Anthony Cox (@drarcox) led me to this article in the American Journal of Pharmaceutical Education.

    In this study, 72 second-year pharmacy students were given “medications” (Starburst JellyBeans) to take with varying administration schedules. The table below shows the results of the little experiment, and it speaks volumes.

    Not surprisingly a “once daily” regimen was the easiest to follow, but still resulted in more than 10% of the doeses being missed. As the regimens grew in complexity, the percentage of missed doses increased.

    We did a similar experiment with M&M’s when I was a pharmacy student at UCSF. The results were similar, i.e. the more complex the regimen, the harder it was to adhere.

    Oh, and these were pharmacy students we’re talking about here. What do you think happens when you ask the average non-healthcare professional to adhere to a medication regimen?

    The entire article is available for free here.

  • Medication reconciliation on an internal medicine unit in French hospital [Article]

    Interesting abstract from Presse Medicale (Paris, France) talking about medication reconciliation on an internal medicine unit in a French hospital. The authors found lots or discrepancies, which isn’t a surprise. They also found that pharmacists could help identify and correct many of the discrepancies, which also isn’t a surprise.

    Like many other articles I’ve read recently, this one is from data collected quite a while ago. The information was obtained from 61 patients between  June and October 2010. The article is from the March 2012 issue of the journal. I always marvel at how long it takes study results to get published.

  • Pharmacy technician program standards draft from ASHP now available for comment

    This was part of my ASHP NewsLink today - A draft of the updated, revised “Accreditation Standards for Pharmacy Technician Education and Training Programs” [from ASHP] is now available for comment until September 28. After this date, another draft will be developed and made available for one more round of comments.

    According to the document “the role of the pharmacy technician is evolving and varies according to state and setting. This role description draws on the one developed by the Pharmacy Technician Educators Council (PTEC)”, and the standards have been developed to:

    • protect the public,
    • serve as a guide for pharmacy technician education and training program development,
    • provide criteria for the evaluation of new and established programs, and
    • promote continuous improvement of established programs.

    You can see the actual document here.

    Kind of cool, except for the fact that the comment period is open until September followed by another round of comments. At this rate we should have a nice set of standards by the end of… uh…hmm, 2013? Woohoo! Light speed ahead.

  • Article: A pharmacist-led information technology intervention for medication errors (PINCER)

    From a recent article in The Lancet (The Lancet, Volume 379, Issue 9823, Pages 1310 – 1319, 7 April 2012)

    Kind of man versus machine study. Actually, it was more like man plus machine versus machine alone.

    “The control group practices therefore used simple feedback; after collection of data at baseline, control practices received computerised feedback for patients identified as at risk from potentially hazardous prescripting and inadequate blood-test monitoring of medicines plus brief written educational materials explaining the importance of each type of error. Practices were asked to introduce changes they considered necessary within 12 weeks after the collection of data at baseline. Intervention practices received simple feedback plus a pharmacist-led information technology complex intervention (PINCER) lasting 12 weeks.”
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  • 2012 ISMP Med Safety Self Assessment for Oncology now available

    The Institute for Safe Medication Practices (ISMP), ISMP Canada and the International Society of Oncology Pharmacy Practitioners, have launched the 2012 ISMP International Medication Safety Self Assessment for Oncology. The tool is used to “identify a baseline of oncology-related medication practices and opportunities for improvement.” ISMP is asking that any practice setting that administers chemotherapy get an interdisciplinary team together to go through the assessment; hospitals, ambulatory cancer centers, physician office practices, and so on. Once the assessment is completed the information can be submitted anonymously online through June 29, 2012.

    These self assessment tools are kind of cool. ISMP will aggregate the results and your facility can use the information as a measuring stick to compare your facility to others. The Oncology self assesssment tool can be accessed on the websites of all three organizations (www.ismp.org, www.ismpcanada.org, www.isopp.org).

    ISMP has other self assessment tools as well. You can see them all here.

    I went through the Automated Dispensing Cabinets and Bar Coding Assessments when I was still practicing as an Informatics Pharmacists. They’re quite helpful in jumpstarting the thought process.

  • Results from ISMP’s survey on IV storage and beyond use dating show confusion, lack of standards

    Beyond use dating (BUD) is a bit of a hassle in acute care practice. The reason is that regulatory bodies have muddied the water with information that isn’t always the most recent or evidence based. ISMP recently published information from a survey of 715 pharmacy professionals on drug storage, stability, and beyond use dating of injectable drugs, and the results are a bit disappointing. There’s clearly a lot of confusion out there, in addition to a plethora of different practice models.

    For me the reference of choice for stability, storage and compatibility was always the Handbook on Injectable Drugs, now in its 16th Edition. This reference was affectionately known as “Trissel’s” because the author of the book Lawrence A. Trissel is a legend in the field of injectable drugs. After Trissel’s I’d do a literature search to see if I could find something that wasn’t in there; typically I couldn’t. And finally, if I couldn’t find it in Trissels’s or the literature, I’d look at the manufacturer’s information.
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  • ASHP Summer Meeting 2012 full of pharmacy informatics stuff

    I attended the ASHP Summer Meeting last year in Denver, CO for the first time ever. The Summer Meeting was much smaller than the infamous Midyear Meeting, but I must say that there were some great informatics sessions. You can read about my experience last year here:

    Well, it looks like the 2012 Summer Meeting is primed and ready to offer just as much interesting informatics stuff this year. The meeting takes place in Baltimore, Maryland June 9-13, 2012. Hope to see you there.
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