As usual there were a lot of things that happened during the week, and not all of it was pharmacy or technology related. Here’s a quick look at some of the stuff I found interesting.
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Tag: Medication Safety
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“What’d I miss?” – Week of November 29th
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Cool Technology for Pharmacy
Entering and making pediatric drips for pharmacists working in an adult hospital can be a real sphincter tightener. Pharmacists that aren’t accustomed to working with pediatric patients feel a little bit uneasy when an order shows up for a customized dopamine, dobutamine, etc. I remember working in a pediatric facility where we did this kind of thing all the time and no one gave it a second thought. We used a combination of two standardized concentrations, hi and low, for each commonly ordered drip. For code blue situations we often used the “Rule of 6’sâ€, which is now discouraged by the Joint Commission.
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Cool Technology for Pharmacy
Researchers from the Technische Universität München (TUM) have developed a small microchip that can automate the process of testing the activity of cancer drugs against a patient’s tumor cells.
The chip is just a few millimeters in size, but packed with sensors. Here, a ceramic version of the chip is shown. The microsensors on the chip record, among other things, changes in the acid content of the medium and the cells’ oxygen consumption; photographs of the process are also taken by a microscope fitted underneath the microtitre plate. All of the data merge in a computer that is connected to the system, and which provides an overview of the metabolic activity of the tumor cells and their vitality.
The robots and microtitre plates are kept in a climatic chamber, which, through precisely regulated temperature and humidity, provides an environment similar to that of the human body, and also protects the tumor cells against external influences that can falsify the test results.
After the tumor cells have been able to divide undisturbed for a few hours, the robot applies an anti-cancer substance. If their metabolic activity declines over the next day or two, the active substance was able to kill the tumor cells and the drug is effective. Using the microchips, twenty-four active substances or combinations of active substances can be tested simultaneously in this way.
The reason that such technology is so important is obvious; treatment with chemotherapy is dangerous and unpleasant for patients. The ability to automate the identification of an ideal chemotherapy regimen not only decreases the patient’s exposure to unnecessary chemotherapy, but speeds up the entire process as well.
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Pharmacist perception of Wikipedia as a drug information resource
The Annals of Pharmacotherpy (Vol. 43, No. 11, pp. 1912-1913): “Approximately 80% of pharmacists use the Internet to obtain drug information.1 Wikipedia, often found at the top of Internet search results, is a free-access, collaborative, online encyclopedia that can be edited by anyone.2 Incidents of vandalism have occurred, since the site allows anyone to contribute. For example, an incident occurred in which a fake biography was created as a joke to implicate prominent writer and journalist John Seigenthaler for the assassination of John F Kennedy. It took about 4 months until the fake biography was detected and deleted by Wikipedia.3 Although Wikipedia does have an internal quality review, the ability of internal editors to find and correct erroneous information may not be timely. As reported by Clauson et al.,4 the information found on Wikipedia may not be complete and accurate, especially in regard to drug information. Published data regarding pharmacists’ use of Wikipedia to obtain drug information is lacking. Therefore, the objective of this study was to measure pharmacists’ use and perception of Wikipedia for obtaining drug information.†– This letter to the editor discusses the results of a questionnaire given to pharmacists regarding the use of Wikipedia for drug information. I was disturbed to read that 28% of respondents reported using Wikipedia for drug information. Strange that it doesn’t appear on any of my drug information resources lists, and never will. I expect better from pharmacists. -
“What’d I miss?” – Week of November 5th
As usual there were a lot of things that happened during the week, and not all of it was pharmacy or technology related. Here’s a quick look at some of the stuff I found interesting.
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Comments and discussion regarding allergy post
My post from yesterday about allergies spurred some great comments on Twitter from @omowizard and @psweetman. I read the discussion between @omowizard and @psweetman with great interest and wish I would have been awake to participate. Unfortunately I was already counting sheep when the conversation took place. The discussion also made me realize how difficult it is to carry on a serious conversation with the 140 character limit imposed by Twitter. What we need is a place where a conversation can extend beyond the 140 character limit. Oh, wait, we have that; friendfeed. I digress.
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Who should collect allergy information and how should it be done?
A pharmacists review of a patient medication regimen is never complete without a thorough evaluation of the patients allergy history. Unfortunately our hospital information system suffers from the inability to prevent people from being human and making mistakes. Our clinical information system permits ‘free texting’ of allergy information, resulting in misspelled drug names and therefore allergies that aren’t electronically checked against medication orders. You know the old saying: garbage in, garbage out.
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Thinking about Clinical Decision Support (CDS)
I attended at webinar today on “Achieving Meaningful Use – The Importance of Clinical Decision Supportâ€. Overall the information was pretty good. It wasn’t exactly new information, but it never hurts to hear something again. The webinar got me thinking about Clinical Decision Support (CDS).
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For those that need a reason to support CPOE and EMR implementation
Pharmacists see hand written orders like the one below almost daily. The order has to be interpreted by a pharmacist, usually with a little hand waving and guessing (kind of like being a pharmacy Jedi), and entered on the patient’s medication profile before the nurse can access the medication from the automated dispensing cabinet and get it to the patient. Even though I’m used to looking at orders like this, there is simply no excuse for what you see below.
There are two medications contained in the hand written orders below. I double-dog dare you to find them. It’s kind of like a “Where’s Waldo†puzzle. Leave your guesses in the comment section of this post. Good luck.
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Are e-patients better informed or just harder to treat?
I found an interesting article at EHR Bloggers that talks about the possibility of easy access to information via the internet resulting in difficult-to-treat patients and higher healthcare costs.
The concern raised in the NPR article describes the effect of information dissemination without context or interpretation – it happens anyway, with direct-to-consumer advertising in all forms of media, and it happens even faster with the Internet. And when patients, armed with these “facts†and the questions they raise, come to their physicians – the physician is often hard-pressed to put things into perspective. The result? Often, very-low-yield tests (or even unnecessary tests that raise the risk of harm through adverse events) and unnecessarily expensive treatments are agreed-to, simply because it’s the path of least resistance.
The problem isn’t with informed patients; it’s the model we’ve developed in our current healthcare system. The article speaks about limited time for physicians secondary to fee-for-service care. This is similar to what retail pharmacies have done with much of outpatient pharmacy services. Most retail pharmacists will tell you they spend more time fighting with insurance companies then they do talking with patients about their medications. One of the most enjoyable times of my pharmacy career was a short stint I spent working for a small independent pharmacy in San Jose. The owner/pharmacist that I worked with had a genuine interest in his patients, knew them by name and offered sound therapeutic advice. His patients appreciated his time and knowledge and were better informed to make important decision because of it.
The article goes on to offer some thought provoking ideas for closing the gap between our current healthcare model and well informed patients. It’s interesting stuff. If you have a moment I recommend you read the entire thing.