Jerry Fahrni

Tag: Patient Safety

  • Quick Hit – Technology doesn’t replace critical thinking

    I’ve had a couple of eye opening conversations over the last week that have me concerned about the thought process surrounding pharmacy technology, where we’re going with it and what it’s supposed to do for us.

    Rule #1: “That’s what the computer told me to do” simply isn’t justification for doing something that makes no sense. Computers are dumb. They do what we tell them, albeit very well, but they don’t think independently from the human operating them. It’s ok to question the decision made by technology if it doesn’t make sense clinically or logically. Drug errors occur for many reasons. And as humans we make mistakes and healthcare professionals are not exempt. Technology can be used as an additional barrier between a potential mistake and the patient; however pharmacists and nurses should not decrease their vigilance at any point in the medication distribution and administration process secondary to new technology.

    Rule #2: technology implementation should not complicate your process. A complicated process is one that is destined to lead to frustration and create opportunities for mistake. Take advantage of technology to streamline a process. Create a better workflow, not a more cumbersome one.

    I think the two things mentioned above are simple common sense, but somehow they get overlooked all the time. Just a thought.

  • Cool Technology for Pharmacy

    Bar code medication administration (BCMA) is nothing new, but remains a hot topic in healthcare nonetheless. Another topic that has generated significant interest in healthcare over the past couple of years is the use of smart pumps, which I have posted on before. Unfortunately for most hospitals the two remain independent of one another with no appreciable integration. The integration of smart pumps with BCMA was one topic of discussion at this years ASHP midyear. I attended a couple of presentations from healthcare systems that had successfully integrated information from their pharmacy information system (PhIS) directly into their smart pumps for use with their BCMA system. Like many other ideas presented at large conferences, the situation is the exception rather than the rule.
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  • Conceptual design for electronic communication in the outpatient setting

    From Implementation Science 2009 Sep 25;4:62:

    Abstract:

    BACKGROUND: Health information technology and electronic medical records (EMRs) are potentially powerful systems-based interventions to facilitate diagnosis and treatment because they ensure the delivery of key new findings and other health related information to the practitioner. However, effective communication involves more than just information transfer; despite a state of the art EMR system, communication breakdowns can still occur. 123 In this project, we will adapt a model developed by the Systems Engineering Initiative for Patient Safety (SEIPS) to understand and improve the relationship between work systems and processes of care involved with electronic communication in EMRs. We plan to study three communication activities in the Veterans Health Administration’s (VA) EMR: electronic communication of abnormal imaging and laboratory test results via automated notifications (i.e., alerts); electronic referral requests; and provider-to-pharmacy communication via computerized provider order entry (CPOE). AIM: Our specific aim is to propose a protocol to evaluate the systems and processes affecting outcomes of electronic communication in the computerized patient record system (related to diagnostic test results, electronic referral requests, and CPOE prescriptions) using a human factors engineering approach, and hence guide the development of interventions for work system redesign. DESIGN: This research will consist of multiple qualitative methods of task analysis to identify potential sources of error related to diagnostic test result alerts, electronic referral requests, and CPOE; this will be followed by a series of focus groups to identify barriers, facilitators, and suggestions for improving the electronic communication system. Transcripts from all task analyses and focus groups will be analyzed using methods adapted from grounded theory and content analysis.

    Although the information in the article is only a design concept, it is still worth reading. Concepts like these could be useful for many outpatient as well as many inpatient alerts; labs that are outside normal parameters, results from blood tests, incorrect antibiotic choice following culture results, etc. With the advances in mobile technology, especially mobile communication devices, this is worth serious consideration.

  • Pharmacy technology – Automated dispensing

    PROmanager-Rx is an automated system from McKesson designed for dispensing unit-dosed oral solids. PROmanager-Rx has a 12,000-dose capacity and uses a conveyor system and bar-code scanner to fill orders generated through the pharmacy information system.

    The system automates storage, dispensing, restocking, and various inventory management functions via the McKesson Connect-Rx software platform. And of course the system interfaces with McKesson’s pharmaceutical distribution system.

    According to the McKesson product brochure:

    The PROmanager-Rxâ„¢ system helps hospital pharmacies get the most out of manufacturer packaged oral solid medications. And relieves the burden of medication packaging.

    It’s the only fully automated system that directly stores and dispenses pre-packaged oral solids. PROmanager-Rx is ideal for patient-centric filling. Bar-code-driven robotics scan every dose for the greatest possible safety and accuracy.

    Pharmacists are freed from packaging and dispensing activities so they can play more integral roles on the clinical care team. Bar-code scanning also simplifies tasks such as managing returns, expired meds, and overall inventory.

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  • Cool Technology for Pharmacy

    The ValiMed Medication Validation System by CDEX, Inc.

    According to the ValiMed website:

    CDEX’s technology stands alone, able to precisely identify medications in real time with its patented Enhanced Photoemission Spectroscopy technology.

    Energy at a preset wavelength interrogates the selected substance, capturing a unique emission spectrum which is then compared to the propriety signature, resulting in a simple “VALIDATED” reading when matched.

    Each medication reveals its own distinct and easily readable signature. By comparing the fingerprint of a tested medication against the signature for that medication in our data library, the ValiMed technology is able to verify a match, presuming there is one.

    The ValiMed Medication and Narcotic Validation System offers superior value to hospital medication safety programs and quality control processes by:

    – Providing immediate, real-time validation of the substance itself.

    – Providing an opportunity to standardize and optimize internal medication safety processes including Training, QA and Regulatory Compliance.

    – Providing a real-time means of validating narcotic returns and mitigating narcotic diversion.

    – Providing pharmacy staff and clinicians with a simple, fast, straightforward and cost-effective way to ensure that the RIGHT drug in the RIGHT dose is administered to the patient.

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  • Sad, but all too common experiences with healthcare

    I read Warner Crocker’s musings at GottaBeMobile as well as his Tweets via the @LPH/tablet-pc-enthusiasts list on Twitter. Warner also has a second blog called Life On the Wicked Stage: Act 2, which I do not read with any regularity. I was, however, driven toward his personal blog secondary to a Twitter post. The post, titled Rush and My Mom: Two Different Care Experiences, talks a little about his experiences with his mothers medical care. She is apparently very ill with lung cancer. I sympathize with Warner as my mother-in-law, Mary Lou, succumbed to lung cancer in December of 2008. I also understand much of what he is talking about as my wife and I experienced similar problems during Mary Lou’s chemotherapy, pain management and surgeries.
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  • Technology to prevent medication errors (article)

    Forni A, Chu HT. Technology Utilization to Prevent Medication Errors. Curr Drug Saf. 2009 Oct 7 [ePub]

    This is a nice review article explores current technologies available to healthcare and what role they play in the reduction of medication errors. The article provides a short review of literature to support each technology reviewed. Technologies covered include: Computerized Physician Order Entry (CPOE), Clinical Decision Support Systems (CDSS), Patient Monitoring: Electronic Surveillance, Reminders, and Alerts, Telemedicine, Bar Code Medication Verification (BMV), a.k.a. Bar Code Medication Administration (BCMA), Smart Infusion Pumps, and electronic medication administration record (eMAR).

    The article concludes with:

    The implementation of health information technology can result in a reduction in ADEs and can impact the quality of patient care. Systems integration and compliance are vital in achieving a safe medication use process. Hospitals that have extensive computerized technology and have greater automation tend to have better patient outcomes, including fewer complications, reduced inpatient mortality and lower hospital costs. Regulatory agencies and payers are now using performance standards and financial incentives to force practices changes. This may increase the speed and likelihood of technology implementation. While many providers may dismiss technology as being beyond their scope of practice or responsibility, both practitioners and patients should be prepared for these changes.

    It’s time for healthcare system to take note of this and begin planning accordingly. You can’t escape the explosion of technology available, nor can you afford to ignore the implications of choosing not to use it.

  • Solution to illegible handwriting puzzle

    Thanks for all the people who ventured a guess. Only the medications are transcribed and the original image is posted below the answers as a reference.
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  • Clinical Surveillance

    There is a nice article in the November 2009 issue of Hospital Pharmacy on the use of clinical surveillance in pharmacy. I’ve mentioned these types of systems before here and here.

    From the article:

    Clinical surveillance tools are atype of clinical decision support system (CDSS), providing pharmacists with patient information that has been filtered according to predefined criteria and is presented at appropriate times to enhance patient care. These tools pull data from 3 sources—admission/discharge/transfer (ADT), laboratory, and pharmacy—and use clinical rules to analyze the data and alert the user of instances that meet the rules’criteria. Though there is some variability in methods across the different vendors’ products, these Webbased applications enerally function by interfacing (HL7) with the hospital’s information systems to securely pull the data to the vendor’s server where the data are analyzed against a set of clinical rules. Some vendors allow the client to build their own rules, some provide a foundational set of rules, and others do not allow user-defined rules. This is an important distinction to make when evaluating the different applications.

    For more information try visiting John’s Evernote repository for Clinical Decision Support.

  • Update ASHP #Midyear2009

    Today was a good day for informatics at ASHP Midyear.

    Pharmacy 2.0: How the Web is Changing How We Practice
    This was a great session moderated by John Poikonen (@poikonen), PharmD or RxInformatics.com. John defined Pharmacy 2.0 as the combination of ASHP’s practice model, participatory medicine, health reform, and self-reform, i.e. changing the way you work. In an interesting move Poikonen asked the audience how many of them were familiar with the term “hashtag” and mentioned the use of #Midyear2009 as a way to follow the meeting on Twitter. Unfortunately very few pharmacists raised their hand to acknowledge the term. I wish we had a way to quantify the number, but it was only 10-20 in a crowd of a couple hundred. It’s obvious that the crowd had an interest in the subject by their presence, but as I already suspected pharmacy has a long way to go before we can be considered tech savvy.

    Todd Eury (@toddeury) of Pharmacy Technology Resources and Pharmacy Web 2.0 presented on “Healthcare System Communications Evolution: Pharmacy and Web 2.0”. In his presentation he introduced many of the most commonly used social media available today; specifically LinkedIn, Twitter and Facebook. He did an excellent job of defining their role in pharmacy practice and communicating not only their benefits, but pitfalls as well. One thing of particular interest in Eury’s presentation was the need to monitor your online reputation and occasionally “Google yourself”. Try it; you’ll be surprised at what you find.

    Kevin Clauson (@kevinclauson), PharmD of Nova Southeastern University College of Pharmacy presented “A Pharmacist’s Web 2.0 Toolkit for Information Management.” He covered the use of RSS Readers, like Google Reader, PeRSSonalized, and Clinical Reader, as well as Twitter and Evernote as a way for pharmacists to keep up with the ever changing world of information that we have to digest and assimilate. I consider myself pretty well versed in the ways of the web, but Kevin offered up some great pearls of wisdom that I can immediately put into practice.

    The final segment of the Pharmacy 2.0 session was a video presentation by Dr. Daniel Sands (@drdannysands) in which he spoke about physician’s use of social media and the web to communicate with his patients. He also covered ways that patients can get involved in their own healthcare through the use of online societies specific to their condition. Dr. Sands spent several minutes in the video interviewing physicians in his own practice about their views on social media and its impact on their relationship with patients. Not surprising some physicians spoke positively about the technology, while others were not so flattering.

    Pharmacy Informatics Education Networking Session
    This session offered up some of the most interactive discussion that I’ve been involved with during my time here at Midyear. The discussion centered on what informatics education standards should be for pharmacy students and how that should translate into a “qualified informatics pharmacist”. It was interesting to see the difference in opinions from pharmacist to pharmacist. While I won’t go into exactly what was covered I think everyone in that room needs to remember that pharmacists are highly educated clinicians that deserve to practice informatics at that same level. A <insert title here; clinical informaticist, Informatics pharmacist, pharmacy informaticist, clinical informatics pharmacist, medication management informaticist> should not be the guy sitting in a cubicle writing reports day in and day out, or the guy that has to edit each line item in the pharmacy information system because “G” should be “GM”. The <insert title here> should be the individual involved in making sure that systems are designed to include pharmacy workflow, that the reports being written provide the necessary information to be clinically relavent, that current clinical standards are adhered to during implementation of new systems, be the representative at the table during discussions of integration and interoperability of hospital systems, etc. Pharmacy informatics is a young discipline and a step in the wrong direction can harm the profession for years to come.

    Informatics Bytes 2009: Pearls of Informatics
    This session, which is still going on, has a little bit of everything when it comes to pharmacy informatics and patient safety. They announced that the session would be recorded. Maybe they’ll even create a podcast out of it; one can only hope.