Jerry Fahrni

Tag: Patient Safety

  • An infusion pump that can be used around MRI scanners…Cool!

    pumpsyringThe MRidium 3860+ from IRadimed is the first non-magnetic iv pump with integrated SpO2 monitoring designed specifically for use around MRI scanners. According to the manufacturer: “The new 3860+ offers significantly upgraded performance and features to the already proven MRidium MR IV pump product line. With the addition of a 10 key numeric input keypad and its wider pumping range of O.l mL/Hr to 1400 ml/Hr, the 3860+ series allows quick programming and broad fluid flow control. The drug library has been enhanced to allow user profiles to be stored and easily transferred via the SD memory card to other pumps. With the addition of the Masimo SET Sp02 monitoring and specialized fiber optic sensor, the 3860+ facilitates both safe sedation AND monitoring in one portable MR safe unit. Approved for use in 0.2 to 3 T Magnets. Features: Dose Rate Calculator, Bolus Dose Programming, Secondary Drug Delivery, Syringe Delivery, Adjustable Occlusion Pressure, KVO, SpO2 monitoring, and Alarm Settings, [and] CQI Data Ability w/Tracking Software which records up to 3000 Entries.” A couple of things that stand out, besides being able to use it around an MRI scanner, are the wide range of infusion rates and the ability to use standard 10 to 60 mL syringes with the MRidium Syringe Adapter IV Set (image shown). I’ve seen several pumps that limit users to 999 mL/hr, which can create an issue in certain circumstances. The ability to utilize syringes comes in handy for pediatrics; most pediatric infusions require an entirely different pump.

    Pharmacists aren’t typically interested in infusion pumps, but they catch my eye from time to time since my involvement with the Alaris Smart Pump project at our facility.

  • Needle-free injection system

    The Engineer:

    The Pyrofast system uses a fine, high-pressure jet stream to penetrate the skin and deliver liquid or solid drugs to the tissue beneath. According to the German company, the entire process takes 40m/s and creates a puncture that is four times smaller than that caused by conventional needle injections.

    pyrofastDr Thorsten Rudolph, managing director of Anwendungszentrum Oberpfaffenhofen (AZO), is working with IP management company, Patev to commercialise the technology. He claims that the system will prevent the transmission of blood-borne diseases via needlestick and sharp injuries and provide a more attractive option to patients generally.

    ‘The pyrotechnical gas propulsion technology that is used doesn’t cause bleeding, so the transfer of diseases such as HIV will be eliminated,’ he said. ‘This is the same chemical gas technology being used in airbags to provide a fast and reliable pressure profile. Including it in an injection system means that it can easily be used by patients to self administer drugs through the skin.’

    Most needle-free injection systems produce the initial penetration pressure using a spring or compressed gas. This can cause discomfort to the patient as the pressure applied is not uniform. Patev claims that the system overcomes this by using chemical substances that, after activation, generate a gas to create a constant and reliable pressure profile.

    The system also has the advantage of distributing the drugs to a wider area under the skin and therefore speeding up absorption, whereas needle injections cause a bolus that slows drug delivery.

    The team has developed a prototype and Rudolph is confident of working with industrial partners to begin trials in the near future.

    You can read more about it here.

  • Is bar code scanning really safer for pharmacy?

    This is a great questions and one that I previously would have said is a no-brainer. I believe a bar coding system for medication dispensing from the pharmacy is an improvement in patient safety, but I would be hard pressed to prove it. A colleague of mine (John Poikonen at RxInformatics.com) is fond of saying that there is no evidence to support the use of bar coding. Here’s a quote from John: “The pharmacy profession is drunk with the notion that BCMA works for patient safety, in the face of little to no evidence.“ He has a point.
    (more…)

  • Verbal orders won’t necessarily go away after CPOE implementation

    AMN Healthcare: “A new AHRQ-funded study found that of roughly 973,000 orders that physicians at a large, Midwestern hospital gave nurses over a 12-month period, roughly 20 percent were verbal orders. The hospital transitioned from a paper-based to computerized provider order entry (CPOE) system during the study period. The new study is one of the first to examine how the content of verbal orders or the context in which they are given might increase risk of error. Although more hospitals are converting totally or in part to CPOE, most experts expect verbal medical ordering to continue to be used extensively for the foreseeable future. According to the researchers, who were led by the University of Missouri’s Douglas S. Wakefield, Ph.D., five factors potentially contribute to verbal orders causing medical errors—type of care setting; time of day or week; type of communication and related variables, such as the physician’s and/or nurse’s accent and articulation; the providers’ knowledge of the patients for whom the order is being given and previous contact experience between the physician and nurse; and environment including background noise and staffing levels. The study, “An Exploratory Study Measuring Verbal Order Content and Context,” was published in the April 2009 issue of Quality and Safety in Health Care.” “– There really are very few excuses for giving verbal orders in a facility that utilizes CPOE. A couple that come to mind might be in a true emergency or in the case of a physician being unable to get to a computer. Unfortunately physicians frequently abuse the verbal order system out of laziness, creating a dangerous situation. I’ve had to clarify my fair share of verbal orders that were poorly transcribed from the physicians lips, to the nurses mind, and finally onto paper. There are simply too many variable during the process. It’s like the old game where you start a rumor with one person and have them pass it on to someone else and so on down the line. At the end of the line, you have a garbled mess. Verbal orders are like that. CPOE is implemented as a safety feature to reduce prescribing and transcription error, but to benefit from the feature physicians have to use it.

  • 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.

  • The use of speed bumps in healthcare

    speed_bumpsOne day last week I was driving home and happened by a school that doubles as a community swimming pool in the summer. The street had several large speed bumps, forcing me to move rather slowly. I’m usually irritated by speed bumps because they slow me down. This day, however, I was happy they were there because a little boy darted out in front of me. I drive a ¾ ton Ford f250 crew cab pick-up. It’s big and heavy. I have serious doubts that a child would stand much of a chance if they went head-to-head with my truck. Fortunately I was coasting along at a safe 10 MPH secondary to the speed bumps and easily came to a stop at a comfortable distance away. At that moment I was thankful for the safety feature built into the pavement on the road, i.e. the speed bumps.

    (more…)

  • Is patient safety recession-proof?

    AMNews: “Protecting patients from harm is medicine’s bedrock goal, but the resources required to do so have never come cheaply. With the recession taking its toll on the health sector, doctors and other medical professionals who have tackled problems ranging from hospital-acquired infections to patient falls find their efforts increasingly scrutinized on dollars-and-cents grounds. Ninety percent of hospital CEOs have cut administrative expenses, staff and services amid the recession, according to a survey of more than 1,000 chief executives released in April by the American Hospital Assn. More than three-quarters said they cut capital spending and nearly half scaled back ongoing projects.” – Healthcare administrators don’t want to admit it, but it is clear that you can put a price on patient safety. As I mentioned in a previous post, projects that directly affect patient care are being cut secondary to a lack of funding. The only real question is how much patient safety is worth. I had projects cut that ranged in cost from $10,000 to well over $100,000. What’s the ROI on reduced adverse patient outcomes? Arguments can be made for cost savings associated with several patient safety measures, but hospital administration will argue that this cost saving is “soft money” and simply can’t be tallied in a column. While this is true, we must continue to advance technology, and with it, patient safety. It’s just going to be a little tricky, that’s all.

  • Possible restriction on acetaminophen dosing

    Medscape.com: “The FDA should put new restrictions on acetaminophen, an advisory committee recommended Tuesday, saying the move would protect people from the potential toxicity that can cause liver failure and even death.” – Acetaminophen (a.k.a. Tylenol) is a very safe medication. According to the article “billions of doses of acetaminophen are used safely every year.” That’s billion, with a “b”. So why would you want to restrict it? That’s a good question. I certainly don’t have an answer.

    Here are a few things to consider if you use acetaminophen:

  • Keep the dose to a maximum of 650mg if you’re a healthy adult.
  • Check with your doctor or pharmacist if you have any health related issues prior to using acetaminophen (liver problems are especially problematic).
  • Make absolutely sure there is no acetaminophen in any of the prescription medications you take (i.e. Vicodin, Norco, Tylenol #3, etc).
  • Don’t take acetaminophen more often than every 6 hours unless directed so by your physician.
  • Be cautious when using over the counter (OTC) medications with multiple ingredients. READ THE LABEL. If the item claims to take care of aches and pains, then it probably has an analgesic in it. You would be surprised to learn where acetaminophen pops up.
  • Don’t drink alcohol when taking acetaminophen; your liver will not be happy if you do.
  • When giving acetaminophen to a child, make absolutely sure to read the directions before use and use only the measuring device supplied with the medication. If you need to measure more than the device is capable, either the child is too old for the dosage form or you’re giving the wrong dose.

    • This issue isn’t so much about the safety of acetaminophen as it is about common sense. Use your head people.

  • NQF calls for pharmacists to take greater role in patient safety

    HealthLeadersMedia.com: “Literature shows that when pharmacists are involved in care, the result is improved patient care, fewer adverse events, and reduced costs,” said Andrawis, speaking about Safe Practice 18. “But, in order for that full benefit to be realized, it’s really important that those pharmacists be given appropriate authority, and consequently that they continue to take accountability for patient outcomes.” – The article goes on to say that pharmacists should be involved in all facets of patient safety including leadership, technology and clinical rolls. Pharmacists are uniquely qualified to address patient safety issues. This is especially true when it comes to the pharmacists roll in the medication distribution model and implementation of new technology such as smart pumps, automated dispensing and barcoding. As the public becomes more aware of issues related to patient safety, the pharmacists roll in saving lives (and money) associated with medication errors will become even bigger.

  • Insight into poor handwriting and why EHRs are important.

    Florence dot com: “1. People who prescribe medications should use a system more sophisticated than the pine straw delivery guy’s [pen and paper] to communicate high-stakes drug information. 1,400 commonly prescribed drugs have names that look-alike or sound-alike. People can, and do, die when drug names are confused with one another.

    2. Pharmacies should be able to receive prescription data in a format that does not require the tenacity of a middle-school math teacher on summer holiday to decipher.

    3. Your electronic medication history–housed with your physicians, pharmacy, and any consumer portal you choose–should move seamlessly into hospital data repositories and be accessible, with your consent, during planned and emergent encounters.”
    (more…)