Jerry Fahrni

Category: Pharmacy Practice

  • ASHP Section of Pharmacy Practice Managers has a new strategic plan

    A little more than a week ago the most recent ASHP Section of Pharmacy Practice Managers Chair’s Message(1) landed in my inbox. I don’t typically read these messages carefully as they’re mostly full of the same old rhetoric. However, this particular message caught my attention because it included information on the ASHP Section of Pharmacy Practice Managers new strategic plan for 2015-2016.

    According to the email:

    “…the Executive Committee recently completed an extensive update to the Section’s strategic plan, which is now available on the Section webpage.  Our intent was to set a structure that would help us continually remain focused on the most important needs of practice managers. We have worked to carefully align the Sections plan with the overall ASHP Strategic Plan. This alignment eliminated the need for separate Section goals, which greatly streamlined the plan.  We also identified critical areas for practice managers.  The critical areas identified for 2015-16 are:

    • Leadership Development
    • Innovation Management
    • Management of the Pharmacy Enterprise
    • Patient Care Quality
    • Multi-Hospital Health System Pharmacy Executives”

    These are all great areas of focus.

    Much more detail can be found the actual strategic plan document, which can be found here. I read through the document, much of which is what you’d expect, but there are some interesting items in the strategic priorities and goals section. Three bullet points caught my attention: 1) Expand pharmacy practice in ambulatory clinics and other primary pharmacy care settings, 2) Produce an Innovative and Timely Professional Journal, Website, Drug Information Compendium, and Other Publications that Meet the Needs of Members and Other Customers, 3) Improve the Discoverability of ASHP Digital Content Assets.

    Expand pharmacy practice in ambulatory clinics – There was a time when I thought all pharmacists should practice in a hospital setting, but my views on that have slowly changed over the years. The most appropriate time for pharmacists to have a meaningful impact on patient care is before they’re hospitalized, i.e. in the ambulatory care environment. We are the medication experts, and nowhere is there more inappropriate medication use than in the outpatient setting. I think it is wise for pharmacy managers to spend more time focused on this practice area.

    Produce innovative and timely information – Times have changed. The amount of readily available information is growing at an exponential pace. Unfortunately not all information is reliable. ASHP has made only small strides in the past several years in improving speed and access to information. Information affecting practice areas like operations, management, and technology should be made available at breakneck speed as it does not require the same rigorous vetting that clinical information does. It is no longer acceptable to wait a year for someone to present their findings at ASHP Midyear, or for AJHP to take months to publish something that is relevant now.

    Improve discoverability of ASHP digital content – This would be a welcome change. ASHP has created a mountain of valuable information, but it’s scattered and difficult to find, cross reference, etc. I could go on and on about this, but suffice it to say I would love to see an improved content management style.

    Let’s hope that Dr. Hoffman is able to make good on his promises. I’m going to hold him to his word.

    ——

    1. The ASHP Section of Pharmacy Practice Managers new chair is James M. Hoffman, Pharm.D., M.S., BCPS, FASHP. With all those initials after his name he must be good.

  • Pros and cons of IV workflow management systems

    Pondering the need for an IV workflow management system (IVWMS)? You’re not alone if you are. According the most recent PP&P State of Pharmacy Automation Survey, 15% of facilities have already implemented something and another 29% plan to do so in the next few years. The only surprise is the relatively low percentage of facilities planning on implementation in the near future.
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  • Is multi-dose packaging really a solution to medication adherence?

    Multi-dose packaging has been a part of pharmacy for longer than I’ve been a pharmacist. It’s mostly been limited to long term care (LTC), such as nursing homes, rehab facilities, etc. It’s not something that’s commonly used in acute care hospitals for a host of reasons, most notably medication regimens frequently change in acute care settings. Multi-dose packaging works best when the patient is stable and medications can be dispensed for multiple days, hence the popularity in LTC.

    Recently articles have been cropping up for companies attempting to use multi-dose packing technology in the ambulatory care setting, i.e. outpatient pharmacy. The most recent of which is an article in the Tampa Bay Times, describing the M5000 robot (1) by MTS Medication Technologies, an Omnicell company. Check the video below.

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  • Using data to build proactive drug error prevention models

    “Data is variously described as the oxygen of the digital economy or the new raw material of the 21st century.“-Nigel Shadbolt

    There are more than a few issues with today’s medication order entry systems. However, in this post I want to focus on only two.

    First, alert fatigue. As a pharmacist that has entered his fair share of orders I can tell you that alert fatigue is real. Order entry systems, including CPOE, are designed to indiscriminately alert users of every possible problem associated with the patient’s profile and the order being entered. When entering orders for a patient with complex medical conditions, this can become a bit frustrating because a majority of these alerts are of little to no value. After a while you begin to blow through alerts because so many are simply a waste of your time. Unfortunately, when this happens you will occasionally miss something important. It happens.

    Second, the “perfect medication error”.(1) This occurs when a physician inadvertently utilizes CPOE to order the wrong medication for a patient – or the right drug for the wrong patient – but the order meets all the necessary checks and balances to end up on the medication profile, i.e. no allergies, meets all appropriate dosing parameters, there are no drug-drug interactions, labs are fine, and so on. This is an issue that appeared on my radar while performing an FMEA for a CPOE implementation when I was still working as an IT pharmacist.
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  • It’s time for pharmacy to find ways to collect and share information

    Regardless of what everyone thinks, the healthcare industry is in the infancy of “big data”. The concept isn’t new, but we still have a long way to go, especially in pharmacy. I recall sitting at conferences years ago listening to sessions describing data collection and manipulation. The problem has been that data, especially that found in pharmacies is scattered across disparate systems without an effective method for connecting the dots. The adoption of electronic health records (EHRs) has made things better, but much of the data collected in an average acute care pharmacy is outside the EHR’s reach.  And to say that most pharmacies have their collective heads buried in the sand, would be putting it kindly.

    Those on the outside often find it difficult to understand the sheer volume of data that’s produced in a pharmacy. Unfortunately, the data sources are mostly stored in disparate systems creating silos, which makes each system blind to the others. Is is possible to connect the systems and exchange data? Sure, but few if any are doing it.

    Data sources in pharmacies come from places like clinical interventions, inventory management, cost containment strategies, regulatory compliance, internal communications, and so on.
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  • What USP <797> has to say about beyond-use dating of stock bags

    Nothing. It says nothing, which leaves things open to interpretation. That’s bad.

    Beyond use dating (BUD) in USP <797> is pretty straightforward, but there’s really no language in there describing stock bags.

    Here are some things to think about. When performing routine compounding, USP <797> states that in the absence of sterility testing, the assigned BUD must not exceed the following:

    USP 797 BUD for temp and risk
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  • JerryFahrni.com Podcast #2: Sterile Compounding Robots

    Show notes:
    Host: Jerry Fahrni

    Robots discussed:
    i.v.STATION by Aesynt
    RIVA by Intelligent Hospital Systems (IHS)
    INTELLIFILL I.V. by Baxter
    APOTECAchemo® by Loccioni Group

  • More thoughts on the ASHP national survey results for informatics and pharmacy practice

    On Monday I spoke briefly about two articles in AJHP that summarize two recent ASHP surveys. The first covers Pharmaccy Informatics in U.S. Hospitals(1), while the second focuses on pharmacy practice in acute care hospitals(2).

    Both surveys contain a wealth of information, and provide a snapshot of what pharmacies in the U.S. are doing. While conducted at different times by different groups, I think it’s more interesting to look at the two surveys together. As I mentioned in my podcast, the adoption of automation and technology goes hand in hand with pharmacy operations. You can no longer have one without the other.
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  • JerryFahrni.com Podcast #1: ASHP National Survey Results

    Show notes:
    Host: Jerry Fahrni

    The two surveys discussed in the podcast are below:

    Fox, B. I., C. A. Pedersen, and K. F. Gumpper. “ASHP National Survey on Informatics: Assessment of the Adoption and Use of Pharmacy Informatics in U.S. Hospitals–2013.” American Journal of Health-System Pharmacy 72, no. 8 (April 15, 2015): 636–55. doi:10.2146/ajhp140274.

    Pedersen, C. A., P. J. Schneider, and D. J. Scheckelhoff. “ASHP National Survey of Pharmacy Practice in Hospital Settings: Dispensing and Administration–2014.” American Journal of Health-System Pharmacy 72, no. 13 (July 1, 2015): 1119–37. doi:10.2146/ajhp150032.

  • The FDA has delayed enforcement of “track and trace”

    Hear that? That’s a collective sigh of relief from pharmacy directors everywhere.

    Modern Healthcare: “The Food and Drug Administration is giving pharmacies another four months before they’re penalized if they can’t document the chain of custody for the drugs they dispense. The requirement was adopted under a 2013 law passed in response to a meningitis outbreak traced to a compounding pharmacy.” – The original deadline for enforcement was July 1. Groups such as ASHP have been lobbying to get the FDA to hold off enforcing the July 1 deadline. Looks like it worked.

    Just in case you didn’t know, the Drug Quality and Security Act (DQSA) was signed into law on on November 27, 2013. Title II of the DQSA, the Drug Supply Chain Security Act (DSCSA) creates new definitions and requirements related to product tracing. The idea of the DSCSA is to build an electronic, interoperable system of tracking prescription drugs (“products”) by November 27, 2023.

    The DSCSA replaces the pedigree requirements of the Prescription Drug Marketing Act (PDMA) and preempts state requirements – killing what California was trying to do – and applies to transactions or changes in ownership of products.

    Under the DSCSA manufacturers, wholesale distributors, repackagers, and dispensers are required to provide the subsequent purchaser with product tracing information when engaging in transactions involving certain prescription drugs, thus creating a barrier for counterfeit medications entering the market.

    People have been scrambling for a while to be compliant, but it’s been an uphill battle for many. I’ve sat through several webinars, and it’s clear that there is still much confusion. It’s a good thing the FDA handed out a four month reprieve. However, it’s unclear whether or not an additional four months is enough.

    You can read more about the DSCSA at the FDA website here. Enjoy!