I received an email today from Pharmacy OneSource outlining their upcoming webinars. Pharmacy OneSource has been offering great webinars for a while now, but these really piqued my interest.
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Category: Pharmacy Practice
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A couple of really nice webinars from Pharmacy OneSource coming up
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Don’t ignore the evidence for the sake of argument
I regularly read a website called Medinnovation. It’s written by Dr. Richard Reece who tends to rant about healthcare in a refreshing way that you don’t often see online. He basically gives you his opinion with both barrels and it typically runs counter to what most people have to say. I like it.
This morning (broke my rule about Sunday morning reading, Doh!) I read his latest post, Medical Experts and the American People. This is one time when I think he got it wrong. In the article Dr. Reece basically chastises evidence based medicine (EBM). “I say “presumably†because many patients or doctors do not necessarily buy the experts’ advice [i.e. evidence based recommendations] or follow instructions.†Uh-oh.
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Cool Pharmacy Tech – Phocus Rx
Ever heard of Phocus Rx? Neither had I until a couple of days ago when my boss sent me a link to this story about Children’s Hospital Los Angeles receiving Phocus Rx as a charitable donation.Phocus Rx is camera system used in pharmacy clean rooms to document and validate the IV compounding process. It consists of two compact 5 megapixel cameras mounted outside the hood in the clean room ceiling or on articulated arm and workflow management software. That’s quite a departure from the other systems I’ve seen where the camera sits in the hood. In addition Phocus Rx includes the obligatory image capture that allows pharmacists to remotely review the compounding process. Pretty cool stuff.
By my count we now have four of these systems on the market, including PHOCUS Rx. Getting pretty crowded in there. Although I have to say that DoseEdge is far and away the most talked about of the IV workflow management systems on the market today. I’d love to play with them side by side to compare features and functionality.
The other systems that I’m aware of include:
- DoseEdge by Baxa (previously mentioned by me here in February 2010)
- Pharm-Q In The Hood (ITH) System by Envision Telepharmacy
- ScriptPro SP Central Telepharmacy System
From the PHOCUS Rx website:
PHOCUS Rx is a powerful camera verification system combining hardware and software. It enables pharmacists and technicians to remotely document and validate the preparation of IV drugs. Two ultra compact 5 megapixel cameras are located outside the hood in the clean room ceiling or on articulated arm. Bi-directional communication software enables pharmacists to review high resolution images and validate or send a warning message.
FEATURES
- scalable and modular system
- non invasive – no wires or devices in hood
- server located outside compounding area
- validate and store images
- barcode recognition
- based on client/server structure
- simple workflow screens
- historical and activity reports
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Effect of med reconciliation on med cost after hospital D/C [article]
The Annals of Pharmacotherapy March 20121
BACKGROUND: Medication reconciliation aims to correct discrepancies in medication use between health care settings and to check the quality of pharmacotherapy to improve effectiveness and safety. In addition, medication reconciliation might also reduce costs.
OBJECTIVE: To evaluate the effect of medication reconciliation on medication costs after hospital discharge in relation to hospital pharmacy labor costs.
METHODS: A prospective observational study was performed. Patients discharged from the pulmonology department were included. A pharmacy team assessed medication errors prevented by medication reconciliation. Interventions were classified into 3 categories: correcting hospital formulary-induced medication changes (eg, reinstating less costly generic drugs used before admission), optimizing pharmacotherapy (eg, discontinuing unnecessary laxative), and eliminating discrepancies (eg, restarting omitted preadmission medication). Because eliminating discrepancies does not represent real costs to society (before hospitalization, the patient was also using the medication), these medication costs were not included in the cost calculation. Medication costs at 1 month and 6 months after hospital discharge and the associated labor costs were assessed using descriptive statistics and scenario analyses. For the 6-month extrapolation, only medication intended for chronic use was included.
RESULTS: Two hundred sixty-two patients were included. Correcting hospital formulary changes saved €1.63/patient (exchange rate: EUR 1 = USD 1.3443) in medication costs at 1 month after discharge and €9.79 at 6 months. Optimizing pharmacotherapy saved €20.13/patient in medication costs at 1 month and €86.86 at 6 months. The associated labor costs for performing medication reconciliation were €41.04/patient. Medication cost savings from correcting hospital formulary-induced changes and optimizing of pharmacotherapy (€96.65/patient) outweighed the labor costs at 6 months extrapolation by €55.62/patient (sensitivity analysis €37.25-71.10).
CONCLUSIONS: Preventing medication errors through medication reconciliation results in higher benefits than the costs related to the net time investment.
Based on the exchange rate mentioned in the study (EUR 1 = USD 1.3443) the six month savings associated with medication reconciliation was about $75 U.S. per patient after factoring in labor. Not exactly earth shattering, but nothing to turn your back on either. At least there’s a positive ROI.
I would have liked to have seen the authors take the study one step further by linking the medication reconciliation savings back to hospitalization readmission and/or effect on the patient’s lifestyle/activity. Once in a while optimizing a patient’s therapy might mean trading a more expensive drug for ease of use or improved patient compliance.
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- Karapinar-Çarkit F, Borgsteede SD, Zoer J, Egberts TC, van den Bemt PM, van Tulder M.Effect of medication reconciliation on medication costs after hospital discharge in relation to hospital pharmacy labor costs. Ann Pharmacother. 2012 Mar;46(3):329-38. Epub 2012 Mar 6. PubMed PMID: 22395255.
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Physician dispensing, that’s some bad mojo right there
Physician dispensing is a hot topic for several reasons. And while I’m not opposed to the use of medication kiosks to dispense medications to patients, I believe that their use must be carefully defined and continuously monitored. As I said in a post in September 2010 “Under the right set of circumstances, and with thoughtful implementation, kiosks could free up pharmacists to spend more time with patients in emergency departments and urgent care clinics across the country. After all, don’t pharmacists argue for more clinical face time with patients and less association with the physical medication dispensing process? That’s what I’ve been hearing from pharmacists for years.” The key part of that quote is “under the right set of circumstances”. You cannot remove the pharmacist form the medication use process. It would be a mistake to do so, and I believe ultimately would lead to increased patient risk. I’ve worked in retail, long-term care, home infusion and acute care pharmacy, and let’s face it, physicians struggle at times to get things right. That’s why God made pharmacists. While I’m not naive enough to think that a pharmacist has to speak to each and every patient about every medication they use each time they receive it, I do think there should be some oversight of the process; regardless of the method of distribution.
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We’re asking the wrong questions
A couple of weeks ago I spent the morning with a friend of mine. He also happens to be a pharmacist and the director of a pharmacy IT group for a medium-sized healthcare system. As one might imagine we have similar interests, which means we spend most of our time together talking about pharmacy; where we’ve been, where we’re going, how to make it better, and so on. We both think that pharmacy is moving at a glacial pace when it comes to making important changes and any real change will likely occur long after we’re both retired.One thing that occurred to us during the conversation was that we always seem to ask the same questions, which always results in the same answers.
- How do make a process faster [to free up pharmacist’s time]?
- How do we make a process more efficient [to free up pharmacist’s time]?
- How do we make a process better [to free up pharmacist’s time]?
- Etcetera
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Why pharmacy continues to fail
I’ve been a pharmacist since 1997. The profession of pharmacy, and therefore the basic principals of the practice, haven’t changed in that time. During my career I’ve worked in six different hospitals (1 in operations, 2 as a clinician, 2 general practice, 1 informatics), one long-term care pharmacy, once as a consultant pharmacist in long term care, in retail for two different retail chains, one community pharmacy and as a relief pharmacist for about a year. Looks pretty bad when I put it in writing. What can I say, I get bored.
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Expanding the role of pharmacy technicians
If you know me then you know that I’m a proponent of expanding the role of pharmacy technicians in the acute care pharmacy setting. I believe pharmacy technicians are underutilized and are capable of doing many functions within a healthcare system to improve patient care, both directly and indirectly, as well as free up pharmacists to do the things they should be doing.
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Telemedicine in rural areas [video]
Seems like a reasonable platform for clinical pharmacy services.
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Eliminating Barriers To Care Using Technology [Video]
Interesting video that talks about the use of telepharmacy for Medication Therapy Management (MTM).
