Jerry Fahrni

Tag: Medication Safety

  • Using bar codes and a cell phone camera to avoid food allergies

    scanavert_beta

    ScanAvert is an application that uses the camera on your cell phone to read product bar codes and compare the ingredients to a personalized allergy list on the company website. The product was launched at the Health 2.0 conference in San Francisco this week and is apparently still in the beta phase.

    Consumers register for the service at our website, creating a profile from the allergy, prescription, dietary requirement/restriction, and illness categories. They may also establish limits on any of the nutritional values, e.g., carbohydrates, calories. In store aisles, customers scan product barcodes, with their auto focus camera phones, to receive instant feedback as to product compatibility/incompatibility and suggested compatible substitutes.

    Our technology will enable shoppers to determine that the products they are purchasing for themselves and their families are compatible with their allergic, prescription, or dietary profiles, e.g., void of peanuts, or, do not contain gluten, an ingredient considered harmful to an individual with Celiac Disease.

    The value proposition of ScanAvert is its simplicity and ease of use for the numerous and varied demographic populations that will reap its benefits. For the supermarket, restaurant chain, or food service vendor, it is a unique way to distinguish itself from competition and to provide a new and valuable service for a significant portion of their customer base.

    ScanAvert uses First DataBank, a well respected drug information source, to check for information on incompatibilities between prescription drugs and substances found in grocery products. This would be a great application for those with food related allergies.

  • “What’d I miss?” – Week of September 20th

    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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  • Cool Technology for Pharmacy

    chipinpillProteus Biomedical: “Proteus ingestible event markers (IEMs) are tiny, digestible sensors made from food ingredients, which are activated by stomach fluids after swallowing. Once activated, the IEM sends an ultra low-power, private, digital signal through the body to a microelectronic receiver that is either a small bandage style skin patch or a tiny device insert under the skin. The receiver date- and time-stamps, decodes, and records information such as the type of drug, the dose, and the place of manufacture, as well as measures and reports physiologic measures such as heart rate, activity, and respiratory rate. The IEM is the cornerstone of the company’s Raisin™ System, which is currently in clinical development. The Raisin™ System measures the body’s response to medications and is intended to improve the management of chronic diseases like heart failure, infectious disease and psychiatric disorders.”

    The Financial Times is reporting that the pharmaceutical company Novartis is partnering with Proteus Biomedical to implant these IEMs into oral blood pressure medications. The IEMs are designed to send reminders to patients, in the form of a text message, when non-compliant with their medication regimens.

    No word on what blood pressure medication they’re using, but Novartis is the maker of Lotrel, Tekturna and Diovan.

    Remember, Big Brother is watching.

  • Librarians and patient safety

    PSQH: “In order to learn whether librarians and information professionals have expanded their involvement in patient safety, the 2007 survey again asked respondents to choose from a list all of the activities in which they participate. In the 2003 survey, only four persons (of 174 total respondents) indicated they had no role in patient safety activities. In 2007, four persons (of 318 total respondents) indicated they had no role in patient safety activities. In 2007, 82.4% of the survey population responds to ad hoc inquiries on patient safety. As in the 2003 survey, this activity ranked first of all the options offered. More than half of persons who responded are also involved in documenting best practices for patient safety from the literature (68.55%), providing targeted alerts on patient safety issues to staff (57.23%), and creating resource guides for patients and practitioners (52.52%).” – During my time as a critical care pharmacist at Community Regional Medical Centers from 2001 – 2006 I spent a fair amount of time in the library researching this and that. Frequently I had to enlist the help of the medical librarian and we soon became friends. Besides being an excellent resource for information, he and I spent quite a bit of time discussing ways to better access and present pharmacy related information. He was a big believer in centralized storage and retrieval of reference material. We didn’t know it at the time, but we were discussing a cloud model. His insight into situations pertaining not only to medical literature, but to patient care was invaluable. He and I have moved on with our careers, he to the VA and me to my current position at KDDH, but I will always remember the value he added to the overall patient care model. I therefore find it all too easy to believe that medical librarians have become an integral part of patient safety initiatives.

  • Cool Technology for Pharmacy

    It’s not uncommon for our pharmacy to unit-dose liquid medications from a bulk bottle; 5mL Donnatal oral syringes, 20mL SMX/TMP and 15mL chlorhexidine unit-dosed cups, etc. Pulling up oral syringes and filling unit-dose medication cups is a manual and time consuming process.
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  • Cool Technology for Pharmacy

    medminder_mayaMaya from MedMinder looks like and ordinary medication organizer with 28 separate compartments representing a week’s supply of medication (7 columns = 7 days/week x 4 rows = AM/Noon/PM/HS). The device uses wireless technology to update MedMinder’s central database with the patient’s medication activity. Patients and caregivers can access this information via the web or receive emails and text messages with reminders and reports.
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  • When does medication safety become counterproductive?

    Being a pharmacist I’m exposed to lots of procedural changes implemented in the name of patient safety. Tall man lettering, black box warnings, pop-up warnings for allergies, drug interactions, pregnancy indicators, lactation indicators, “high risk drugs lists”, shiny labels to identify sound-alike-look-alike-drugs (SALAD), separation of stock for similarly named medications, bar coding, double checking, triple checking, and so on and so forth ad infinitum. As the “IT Pharmacist” I get to see all these changes up close and personal because I’m often involved in their implementation in one way or another. Do we actually have any evidence to support using all these things?
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  • Cool Technology for Pharmacy

    glowcapThe Vitality GlowCaps is a wireless internet enabled cap for prescription bottles that uses light and sound to notify patients when it is time to take their medication. When the GlowCap is removed from the prescription bottle, the information is documented on Vitality’s server. Vitality uses this information to send the patient and physician a monthly compliance report to help monitor therapy. Of course, that’s assuming that the patient doesn’t just open and close the lid when the reminder goes off. When you stop to think of all the time, energy and money spent on patient compliance with medication, you begin to realize that the GlowCap is pretty cool pharmacy technology.
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  • Medicated patch slips into wrong ADC pocket

    cubie

    Hospital Pharmacy: “During the process of with drawing a patient’s nicotine patch from an automated dispensing cabinet (ADC), a carousel pocket opened to reveal 2 nicotine patches and 1 fentaNYL 50 mcg/hr patch. The nurse using the ADC immediately called the pharmacy to report the discrepancy. The pharmacy investigated and found that it was not a dispensing error. Both patches (nicotine and fentaNYL) were stored in the same medication carousel, and the fentaNYL patch slipped over the top of one pocket and into another pocket that contained nicotine patches. Generally, the hospital reserved ADC carousel pockets for controlled substances, but there was a history of pilferage of the nicotine patches when stored in matrix drawers. To deter pilferage, the pharmacy began stocking them in secure carousel pockets with the tracking feature on to count the product. FentaNYL was in a nearby pocket by itself, but when the carousel turned, patches sticking up from the fentaNYL pocket were caught and dragged to another pocket that housed nicotine patches.” - This type of occurrence is more common than you might think. To prevent this type of thing from happening, many hospitals will utilize a system similar to the Pyxis CUBIE system. Pyxis CUBIE pockets are small containers with a clear plastic lid. The lid remains closed until that medication is accessed via the Pyxis medication terminal. This prevents items from jumping to another location.

  • Deaths caused by postoperative hydration

    ASHP: “ Standards Needed for Postoperative Hydration Therapy, ISMP Says – BETHESDA, MD 13 August 2009—Investigations into the deaths of two six-year-old children have prompted the Institute for Safe Medication Practices (ISMP) to call for the establishment of standards of practice for i.v. hydration therapy in postoperative patients.

    According to today’s issue of ISMP Medication Safety Alert!, a six-year-old girl who underwent tonsillectomy and adenoidectomy died after receiving 5% dextrose in water at 200 mL/hr for 12 hours. The postoperative orders had stated “1000 cc D5W – 600 cc q8h,” but the pharmacist entered an incorrect infusion rate into the electronic medication administration record. This error was not noticed until a pediatrician, consulted by the surgeon because the girl had a grand mal seizure, recognized that the patient had signs of hyponatremia and water intoxication. The patient had had seizure-like activity earlier in the day, but the surgeon, contacted by telephone, attributed those episodes to a reaction to promethazine even though the nurses had expressed doubt.

    In the other case, according to ISMP, a six-year-old boy who underwent surgery to correct a malformation in his aorta died after nurses dismissed his parents’ concerns about their son becoming increasingly less responsive on the second postoperative day. The physician had prescribed an infusion of a sodium chloride solution because the boy’s serum sodium concentration had dropped subsequent to treatment with diuretics. No sodium chloride infusion was documented in the medication administration record, however. The nurses attributed signs of hyponatremia to the patient receiving hydromorphone for pain relief and being “fidgety” from pain.”

    Hyponatremia is basically the result of excess water (case #1 above) relative to sodium and is one of the most common electrolyte abnormalities in hospitalized patients. The condition can cause significant morbidity and mortality. Unfortunately incorrectly treating the condition can be dangerous as well (case #2 above).

    Signs and symptoms of hyponatremia are directly related to the central nervous system and include anorexia, nausea, lethargy, headache, apathy and muscle cramps. In severe cases, symptoms worsen and can advance to seizures, brain damage, and even death secondary to cerebral edema.

    Treatment of hyponatremia can be quite controversial as aggressive replacement can lead to osmotic demyelination syndrome (i.e. central pontine myelinolysis); a painful and potentially deadly condition. Unfortunately the brain responds rapidly to a fall in plasma osmolality, but slowly to correction. Complete restoration of solutes in the brain may require up to 5 to 7 days. For this reason, aggressive sodium replacement should be limited to severe cases and patients should be closely monitored for several days following aggressive treatment for hyponatremia.

    Tragedies like those mentioned above should, in theory, never occur. We continue to develop guidelines and technology to prevent such mistakes from ever happening, but will never be able to eliminate the “human factor” so blatantly described above. Our best hope is to create a system that decreases the occurrence of errors and minimizes damage when they occur.