Jerry Fahrni

Tag: Patient Safety

  • Canada calls for national drug shortage registry [article]

    The Canadian Pharmacist Association is looking for a way to track drug shortages. They would like to get drug manufactures and hospitals to participate in a national reporting system. It’s a great idea and one that I think could provide value.

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  • Why regulatory compliance is killing innovation in healthcare

    Anyone that’s worked in healthcare knows about regulatory compliance. If not, then they should because it takes up about 50% of everyone’s time, energy and effort. I understand the theory behind regulations, i.e. protect the patient, but I think most of the time all additional regulations do is is create work for people that are already over burdened.

    Ask a nurse how much time they spend documenting and double documenting things to meet some arbitrary rule or regulation. You’ll be surprised by the answer. Now ask a pharmacist or a physician. You’ll get the same ugly responses. I know a lot of my time as a clinician was spent generating documentation to cover my ass rather than helping care for a patient.

    Unfortunately the need to comply with government agencies and silly rules inside the walls of healthcare has generated an unwanted side effect – lack of innovation. Why? Because all that innovative energy is spent on regulatory compliance instead of other, more useful things.

    I’ve been involved in several conversations over the last month dealing with how to best use pharmacy automation and technology to increase efficiency and solve problems. Would you like to venture a guess as to what most of those conversations centered on? Yep, how to automate some documentation process or create technology to meet some new regulatory compliance. None of the discussions have been about providing better, safer, more complete patient care.

    If you don’t think this is a major problem, think again. I was reading a blog by John Halamka last night in which he discusses the ‘Burden of Compliance’. In the blog John states that “[a]s we draft new regulations that impact healthcare IT organizations, we need to keep in mind that every regulation has a cost in dollars, time, and complexity.” Just remember, there is a finite amount of dollars and time floating around in healthcare these days. If a majority of those dollars and time are gobbled up by regulatory compliance, what does that leave for innovation to actually improve medication distribution, safe administration and better patient care? Precious little if you ask me.

  • The weakest link in building a safer medication use model

    I’ve just spent four days at the ASHP Summer Meeting in Denver, CO. The meeting offered a nice variety of topics, but seemed to focus on medication safety and informatics more this year than in the past. In fact, this is the first year that ASHP has offered a medication safety tract at one of their meetings.

    I avoided the more traditional sessions on therapeutics, choosing instead to focus on the informatics and medication safety sessions. Based on the information presented it was obvious to me that these two disciplines are intimately linked. After all, the idea behind much of the technology we use in healthcare today is to improve patient safety.
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  • Smart Pump integration with EHR and auto-programming [Video]

    The integration of smart pumps with an EHRs, and the use of auto-programming isn’t common place in healthcare, but it should be. I’ve only come across a couple of facilities that have done it “successfully”. In addition I’ve heard a couple of presentations on the subject matter; one at ASHP a couple of years ago and one at the unSUMMIT last year.

    The video below talks about the integration of smart pumps with Cerner at WellSpan Health in New Jersey. Interesting stuff.

  • The tail wagging the dog

    WSJ: “The Food and Drug Administration said Tuesday that it will require some painkiller manufacturers to produce new educational tools in an effort to quell prescription-drug abuse.

    The requirements will affect makers of long-acting and extended-release opioids, which include oxycodone, morphine and methadone.

    Letters have been sent to manufacturers of the drugs describing the medication guides and tools for physician training that are now required, FDA Commissioner Margaret Hamburg said. The FDA will approve the materials, which will also be accredited by professional physician-education providers, she said, a step meant to combat bias in the materials.”

    Oh. My. Gosh. Let me see if I can wrap my brain around this. The FDA is going to require that manufacturers of certain “painkillers” tell physicians how to properly use the drugs instead of requiring physicians to read the literature and do exactly what they’re trained and paid to do. Crud, it’s nothing a good pharmacist couldn’t fix. Why doesn’t the FDA simply require physicians to run these same prescriptions through a pharmacist for approval or give pharmacist prescriptive authority instead. It makes a lot more sense than putting the manufacturers in charge of the asylum. I would be utterly embarrassed if a drug manufacturer had to tell me how to properly use a drug because I couldn’t get it right. I think the healthcare system has officially reached a new low. Unfortunately this ain’t no limbo contest.

  • Cool Pharmacy Technology – Codonics SLS Safe Label System

    Labeling syringes has always been difficult for anesthesiologists in the OR. It must be because they never seem to get it right. If you don’t believe me, just look at the image below. These drugs were found during routine inspection of an OR suite. Well that’s all changed now with the Codonics SLS Safe Label System.
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  • Cleanrooms – the forgotten realm of acute care pharmacy

    Cleanroom environments, a.k.a. IV rooms, inside acute care pharmacies compound some of the most complex and dangerous medications used inside a hospital. Unfortunately this area is often overlooked when implementing safety features such as bar-code verification, identification of high-alert medications, advanced training and competency and so on. I was reminded of the dangers of intravenous products by a recent story coming out of Alabama where the death of 9 patients was linked to TPN (total parenteral nutrition) contaminated with Serratia marcenscens.

    While IV rooms remain a high risk area they tend to fall off the radar of many hospital administrators when it comes to implementing technology capable of reducing risk. USP <797> tends to get all the glory even though much of the guidelines proposed in this USP chapter have yet to be shown any more effective than diligent hand washing and impeccable technique.
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  • Realistic view of medication reconciliation?

    Hospitals & Health Networks: “Despite progress, medication reconciliation remains a bitter pill. Un-intended changes in medications occur in one-third of all patients transferred between hospital departments, and in 14 percent of patients at hospital discharge, according to the Agency for Healthcare Research and Quality.

    Most medication inconsistencies could be avoided if reconciliation were performed at patient admission, transfer and discharge. Hospital information systems are helping some wired hospitals rdo this across the care continuum despite the lack of a universal solution.

    Medication reconciliation was designated a 2005 National Patient Safety Goal by the Joint Commission, which recommended that organizations accurately and completely reconcile medications across the continuum of care. In 2009, however, the commission announced it would no longer score medication reconciliation during on-site accreditation surveys, because of difficulties with implementation strategies. Then, in December 2010, the commission announced a new version of the NPSG (08.01.01), to be effective July 1 of this year. According to the commission, the new streamlined version focuses on critical-risk points in the medication reconciliation process.

    The Institute for Safe Medication Practices still is disappointed in the current status of medication reconciliation. “It’s not what we expected for a process that on the surface seems so simple,” says Stu Levine, an ISMP informatics specialist.”

    I received a link to this article through the Healthcare IS – Pharmacy IT/Pharmacy Informatics CPOE Group on LinkedIn. The article is titled “Medication Reconciliation Only as Good as the IT Allows”. I find the title a little strange, and a bit misleading. Consider that the medication reconciliation process is best handled by diligence among healthcare providers, not IT. The technology to provide clinicians with medication lists is only a tool to make the process easier. Reconciling a patient’s medications is at best a difficult task. The “general public” knows surprisingly little about their own medications; including the simplest of things like names and doses. Getting physicians to reconcile a medication list isn’t much better. More often than not they simply sign the “transfer med list” without really scrutinizing what’s on it.

    Unfortunately the article makes it sound like a simple process of looking at the medication list on admission, transfer and discharge. It really isn’t as simple as that. We utilized this process at my previous hospital and I can tell you that we were lucky to have a patient medication list that was accurate. Most were haphazard attempts that lead to confusion and lots of phone calls and clarification.

  • Cool pharmacy technology – UCSF Robotics

    UCSF: “Although it won’t be obvious to UCSF Medical Center patients, behind the scenes a family of giant robots now counts and processes their medications. With a new automated hospital pharmacy, believed to be the nation’s most comprehensive, UCSF is using robotic technology and electronics to prepare and track medications with the goal of improving patient safety.

    Not a single error has occurred in the 350,000 doses of medication prepared during the system’s recent phase in.”

    Robotics is nothing new, but it seems like everyone is taking notice of the new robotics in the pharmacy at UCSF. I suppose all the people pointing it out to me has something to do with the fact that UCSF School of Pharmacy is my alma mater, but you never know. Anyway, I’m pleasantly surprised to see UCSF taking such an active role in advancing pharmacy practice. When I spoke with some colleagues sill working for UCSF a little over a year ago they were still practicing pharmacy invented in the dark ages. Not any more.

    Now I’m trying to get a hold of someone at UCSF that will let me stop by for a tour, and all of a sudden no one knows me. Poetic justice I suppose.

  • New study equals new opportunity for pharmacists – ADEs in the ED

    The February 2011 issue of Annals of Emergency Medicine has an article that reveals that patients that come through the emergency department (ED) secondary to an adverse drug event (ADE) “had a higher risk of spending additional days in the hospital per month and higher rate of outpatient health care encounters. The adjusted median monthly cost of care was 1.90 times higher (Can $325 versus $96; 95% CI 1.18 to 3.08).” In other words people that suffer and ADE create a burden on the healthcare system.

    The study was conducted in Canada, which by itself holds little significance. But I would wager a guess that most patients in Canada receive their prescriptions from a single primary care physician while patients in the US receive their medications from multiple physicians at the same time, i.e. patients in the US probably have a greater potential for ADEs.

    Medication reconciliation across the healthcare continuum is probably the best weapon we have in the fight against ADEs in the outpatient setting. And who can better manage a patient’s medication reconciliation than pharmacists? Uh, no one. Getting a pharmacist involved sounds like a good investment to me.

     

    Hohl CM, Nosyk B, Kuramoto L, et al. Outcomes of Emergency Department Patients Presenting With Adverse Drug Events. Annals of Emergency Medicine. 2011