The first, and most interesting, session I attended today was “Integrating Technology to Improve Medication-Use Patient Safetyâ€. The session was sponsored by Hospira and consisted of three separate speakers covering areas of the medication–use process where breakdowns typically occur. The focus was on closed-loop medication administration. I’m sure there are different opinions on what closed-loop medication administration is, but for our purposes it consists of orders from the time written until the medication is administered to the patient. Many technologies were discussed, including computerized provider order entry (CPOE), bar code medication administration (BCMA), intelligent infusion devices (IIDs), and electronic medication records (EMRs) among others.
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Tag: Patient Safety
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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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The tech-check-tech model to improve clinical practice
Earlier this year the American Journal of Health-System Pharmacy published “A vision statement by the ASHP Section of Pharmacy Informatics and Technologyâ€. The statement represents thoughts on the current state of pharmacy practice and contains a healthy dose of ideas on how technology can help support and improve pharmacy practice.
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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. -
Dealing with the shortcomings of healthcare information systems
This week has kept me busy dealing with issues surrounding our various clinical systems and how they fit, or don’t fit, into various processes. If you’ve been reading this blog then you are probably a little too familiar with one of the problems; the dreaded allergy issues which I’ve discussed here and here. The issue runs much deeper then I’m willing to go into here, but suffice it to say that it’s been a real pain in the rear. The other significant issue has to do with bar code medication administration and “things we can’t do†with our current system.
Anyway, I’ve been in meeting after meeting this week listening to people argue over things that I consider outside of our control and basically spending a lot of time talking about what our systems can’t do. As you can imagine the discussions can become quite energetic. During one particularly heated discussion I asked a key player to forget about what we couldn’t change and asked them to focus on the issues that could be controlled. The end result was a general consensus that we could control and correct approximately 60% of the problem by working within the confines of the systems and deal with the remaining 40% through education and accountability. The arguing took 60 minutes, the ultimate solution took 15.
Believe me, I am painfully aware of the shortcomings of our various clinical systems, but I really don’t see the need to dwell on things that are outside of my control; a lesson I learned from my wife. Oh sure, I get frustrated and vent every now and then, but the bottom line is that I have to work within the limitations of the systems put in front of me. You see engineers do it all the time; focus on how to make it better not on what can’t be done. I think healthcare professionals could learn a lot from engineers. Just a thought.
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“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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