Jerry Fahrni

Tag: Patient Safety

  • 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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    ugly_order

  • 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.

  • “What’d I miss?” – Week of October 11th

    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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  • 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.

  • BCMA vs. CPOE, Which Comes First? Webinar Results

    argumentPharmacy OneSource hosted a webinar “debate” today that had two excellent speakers presenting their cases for which technology should implement first; Computerized Physician Order Entry (CPOE) or Bar Code Medication Administration (BCMA). The webinar was well worth the time.

    The case for CPOE was presented by John Poikonen, Pharm.D. John is the Clinical Informatics Director at UMass Memorial Health Care, an Academic Medical Center and health system in central Massachusetts. John is an interesting informaticist as he has repeatedly spoken out against the lack of evidence supporting BCMA. It was a good fit for him to argue for CPOE implementation ahead of BCMA. He brought up some great points and presented a fair amount of literature to back them up. You can read more of John’s musings at RxInformatics.com.

    The case for BCMA was presented by Steve Rough, the Director of Pharmacy at the University of Wisconsin Hospital and Clinics, and Clinical Assistant Professor at the UW-Madison School of Pharmacy. Steve has done quite a bit of work with bar code medication scanning technology and presented an excellent case for BCMA.

    Both presenters had valid reasons and good arguments for their positions. I for one am in favor of both CPOE and BCMA, but would personally push for BCMA ahead of CPOE for several reasons. CPOE requires a much larger investment in resources, both human and financial, when compared to BCMA. There is also a reasonable expectation that BCMA will stop errors at their most vulnerable point, the administration phase. I’ve mentioned this before and Steve brought up some of the very same points in his presentation. Finally, CPOE requires buy-in from physicians in order to be completely successful. And if there is one thing you can count on it’s that physicians will fight you tooth and nail when it comes to technology and change.

    You can grab a copy of the presentation slides here.

  • 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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  • Infusion catheter delivers medication with precision

    VascularDesigns:

    Vascular Designs’ IsoFlowâ„¢ infusion catheter … is a dual balloon catheter designed for controlled and selective infusion of physician-specified fluids into selected vasculature by means of temporary occlusion of a target region of the vessel with simultaneous perfusion of blood past the isolated region. With this type of directed approach to fluid delivery, you can increase drug concentrations at targeted sites while reducing systemic exposure, thereby improving efficacy and patient outcomes. This makes IsoFlow ideal for battling diseases such as cancer for which treatment requires the direct infusion of chemotherapy drugs to a targeted region of the body like a tumor.

    The IsoFlow catheter enables sideways perfusion, The IsoFlow catheter enables sideways perfusion, which gives you the ability to push specified fluids both into side branch and angiogenicly formed vessels, letting medications reach an isolated area in a highly targeted and concentrated fashion. With IsoFlow’s unique design, fluids can reach areas that could not previously be treated directly.

    How cool is that.

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