Jerry Fahrni

Tag: Patient Safety

  • Cool Pharmacy Tech – Real time volume detection in syringes

    I received the Tweet below last night from Denis Lebel. The link took me to a YouTube video that demonstrates the use of a camera and software to determine the volume inside a syringe. It’s really cool.

    I had an idea like this about 6-8 months ago. I talked it over with a colleague and they said it couldn’t be done. Well it seems the smart folks at Scorpion Vision Software did what couldn’t be done. Surprise! Denis said they’ve been working on it for about a year. Congratulations are in order as I think this is brilliant.

    Translated text from the video description: “This video shows a proof of concept that allows the detection volume of syringes in real time thanks to the vision software. This real-time detection, combined with the reading of bar code products can be an important addition to the quality control of the preparation of intravenous medications in sterile chamber in pharmacies of health facilities.

    In this video we demonstrate how the Scorpion vision software software identifies the”bar code” that identifies the type of syringe used, the position of the piston and thesyringe body in 3D space and then estimating the volume contained in the syringe.”

  • Article: The costs of adverse drug events in community hospitals

    The article below appeared in the March 2012 edition of Joint Commission Journal on Quality and Patient Safety – yes, that’s a real journal. I couldn’t make this stuff up – Anyway, there’s nothing new here, we all know that ADEs are expensive. How expensive? Well, the bottom line is that “ADEs were associated with an increased adjusted cost of $3,420 and an adjusted increase in length of stay (LOS) of 3.15 days”. Depending on the number of ADEs your facility has you could easily use these numbers to justify the services of a pharmacist.

    The only problem with the information is that it’s from a 20-month period between January 2005 and August 2006. I hate to break it to you Joint Commission Journal on Quality and Patient Aafety, but that makes the information all but useless. Interesting, but useless.

  • Ambiguous and Dangerous Abbreviations article results in interesting comment

    There’s a little blurb in the March 2012 issue of Pharmacy Times about the dangers of using inappropriate abbreviations in prescriptions. The author gives a couple of good examples where the use of abbreviations resulted in errors. I’ve seen my fair share of crappy handwriting and liberal use of abbreviations during my career, and I almost always read articles that talk about the problem. I find them interesting.

    Anyway, there’s nothing particularly interesting about this article, but Mitch Fields, RPh left the following comment:

    Well, yet another article re: dangerous and ambiguous “pharmacy” abbreviations in a pharmacy journal. I’ve seen dozens such articles over the past 30+ years, and they all suffer from the same problem: they don’t belong in the journals of practitioners who READ prescriptions, they belong in the journals of the practitioners who WRITE prescriptions!

    That is one of the most logical things I’ve ever read. Mitch makes a great point.

  • Cool Pharmacy Tech – Phocus Rx

    Ever heard of Phocus Rx? Neither had I until a couple of days ago when my boss sent me a link to this story about Children’s Hospital Los Angeles receiving Phocus Rx as a charitable donation.

    Phocus Rx is camera system used in pharmacy clean rooms to document and validate the IV compounding process. It consists of two compact 5 megapixel cameras mounted outside the hood in the clean room ceiling or on articulated arm and workflow management software. That’s quite a departure from the other systems I’ve seen where the camera sits in the hood. In addition Phocus Rx includes the obligatory image capture that allows pharmacists to remotely review the compounding process. Pretty cool stuff.

    By my count we now have four of these systems on the market, including PHOCUS Rx. Getting pretty crowded in there. Although I have to say that DoseEdge is far and away the most talked about of the IV workflow management systems on the market today. I’d love to play with them side by side to compare features and functionality.

    The other systems that I’m aware of include:

    From the PHOCUS Rx website:

    PHOCUS Rx is a powerful camera verification system combining hardware and software. It enables pharmacists and technicians to remotely document and validate the preparation of IV drugs. Two ultra compact 5 megapixel cameras are located outside the hood in the clean room ceiling or on articulated arm. Bi-directional communication software enables pharmacists to review high resolution images and validate or send a warning message.

    FEATURES

    • scalable and modular system
    • non invasive – no wires or devices in hood
    • server located outside compounding area
    • validate and store images
    • barcode recognition
    • based on client/server structure
    • simple workflow screens
    • historical and activity reports

  • Physician dispensing, that’s some bad mojo right there

    Physician dispensing is a hot topic for several reasons. And while I’m not opposed to the use of medication kiosks to dispense medications to patients, I believe that their use must be carefully defined and continuously monitored. As I said in a post in September 2010 “Under the right set of circumstances, and with thoughtful implementation, kiosks could free up pharmacists to spend more time with patients in emergency departments and urgent care clinics across the country. After all, don’t pharmacists argue for more clinical face time with patients and less association with the physical medication dispensing process? That’s what I’ve been hearing from pharmacists for years.” The key part of that quote is “under the right set of circumstances”. You cannot remove the pharmacist form the medication use process. It would be a mistake to do so, and I believe ultimately would lead to increased patient risk. I’ve worked in retail, long-term care, home infusion and acute care pharmacy, and let’s face it, physicians struggle at times to get things right. That’s why God made pharmacists. While I’m not naive enough to think that a pharmacist has to speak to each and every patient about every medication they use each time they receive it, I do think there should be some oversight of the process; regardless of the method of distribution.
    (more…)

  • Cool Pharmacy Tech – T-Haler

    The T-Haler is a training device developed by Cambridge Consultants to help asthma patients learn how to use their inhalers. Why is this such a cool piece of technology? Because patients invariably do a crapy job using their inhalers.

    I used to ask asthma patients to demonstrate how they used their inhalers, and I was almost always disappointed by what I saw. Most patients don’t understand how to properly use these simple little devices, which ultimately leads to treatment problems, and in worst case scenarios poor control of their asthma.  This is especially true in pediatric patients. Asthma education was a big part of the pharmacist’s job when I worked in a pediatric hospital.

    From the Cambridge Consultants site:

    Cambridge Consultants developed the T-Haler concept, a simple training device. Interactive software, linked to a wireless training inhaler, monitors how a patient uses their device and provides real-time feedback via an interactive video ‘game’. T-Haler provides visual feedback to the user on their performance and the areas that need improvement. These tools could help the estimated 235 million asthma sufferers worldwide to get the most from their inhaler, and potentially reduce the millions spent annually on asthma-related emergency room admissions.

    More than 50 healthy participants, aged 18-60, took part in a recent study conducted by Cambridge Consultants to test the efficacy of T-Haler. Before using the training system, the average success rate of the group in using an inhaler correctly was in the low 20% range – in line with numerous other studies carried out. The participants had no prior experience with asthma or inhalers and were given no human instruction beyond being handed the T-Haler and told to begin. The on-screen interface walked the group through the process, which takes just three minutes to complete.

    The T-Haler measures three key factors for proper inhaler use. First, whether the patient has shaken the inhaler prior to breathing in; second, the force with which they breathed in; third, when they pressed down on the canister (the step which releases the drug). These three variables can determine the efficacy with which drugs are delivered in a real metered dose inhaler (MDI) device.

    As healthcare trends toward a focus on preventive care and devices which offer greater consumer appeal and compliance, innovations such as the T-Haler may soon become the norm in doctors’ offices, pharmacies and clinics.

  • Failure to use “low concentration” alerts properly leads to errors [ISMP Safety Alert]

    When I read the headline in the most recent ISMP Medication Safety Alert! – Smart pump custom concentrations without hard “low concentration” alerts – I didn’t really get it. So what if a smart pump doesn’t stop you from programming “low concentrations”? Well after reading through the article, and the examples, it made perfect sense.

    Failing to employ available dose error-reduction software (DERS) as intended and to heed important clinical alerts are common contributors to these errors. In particular, the misuse of custom concentration options (i.e., user must fill in the concentration) that do not employ a hard (requires reprogramming) minimum concentration limit is a prime example. This issue contributes largely to preventable errors with smart pumps given the counterintuitive, inverse relationship between concentration and volume. More concentrated drugs require less volume to deliver a specified dose; less concentrated drugs require more volume to deliver a specified dose. When using “fill-in-the-blank” custom concentrations, the concentration must be programmed into the pump so it can calculate the volume needed to deliver the prescribed dose. If the programmed concentration is lower than the actual concentration in the infusion bag or syringe, the pump will deliver an overdose. If the programmed concentration is higher than the actual concentration in the bag or syringe, the pump will deliver an underdose. Without a hard minimum concentration limit, the former scenario has led to life-threatening events, such as those described below.

    Here’s a great example from the article that made the light bulb go off in my mind:

    A physician prescribed IV HYDROmorphone 20 mg/100 mL (0.2 mg/mL) to infuse at 2.5 mg/hour. In this hospital, the standard concentration for this infusion was 0.1 mg/mL, so the custom concentration of 0.2 mg/mL had to be entered into the smart pump. The nurse selected the custom concentration option then mistakenly entered 2.5 mg/100 mL as the concentration instead of 20 mg/100 mL. Given the erroneously programmed concentration of 0.025 mg/mL, the pump issued a soft (can be overridden) low concentration alert. The nurse overrode the warning, mistakenly believing the warning was inconsequential. Based on the erroneous concentration, the smart pump infused the drug at a rate of 100 mL/hour, while the intended rate was 12.5 mL/hour. The pump delivered the entire bag of HYDROmorphone 20 mg to the patient in 1 hour.

  • “What’d I miss?” – Week of February February 12, 2011

    I haven’t done one of these in quite a while, but thought I’d try to get back in the groove.

    It’s been a pretty good week, and as usual there were a lot of things that happened during that time. Not all of it was pharmacy or technology related. Here’s a quick look at some of the stuff I found interesting.

    • The Vow was #1 at the box office last weekend. I haven’t seen it. Instead my wife and I went to see Safe House, which was pretty good. It’s no threat to the Bourne series, but I’d see it again. 
    • I thought this was pretty sticking funny. From Robot Chicken. Pay attention at 0:06 in the video. Quite the conundrum.

     

    • HIIMSS12 is next week in Las Vegas. This is the first year I’ve been able to attend and I’m excited. This is the most excited I’ve been about attending a conference in a long, long time. I can’t wait to get there. I’m looking forward to meeting some folks that I’ve only talked to virtually. In addition I’ll be attending my first ever HIMSS 2012 Tweetup with HP on Tuesday, February 21. Details can be found here. Cool stuff, dude.
    • It looks like infant Tylenol oral suspension is on the hook again. More than 500,000 bottles have been recalled. It has to do with the flow restrictor. You can read more about it the ASHP News Site. Infant Tylenol suspension has taken a beating over the years. It begs two questions: 1) why can’t people get this right?, and 2) what do we do in the long run if people can never figure it out? Check the video below for instructions on using Infants Tylenol suspension. It’s not that hard people!
    • How far have we really come with smartphone technology? Actually we’ve come a long way, but have you ever gone back and looked at handheld technology over the years? If you have, you’ll know that it’s basically the same. Take a look at this user guide for one of the Sony Clie PDAs (PEG-NZ90). Yes, yes, it’s quite ugly, but look at the manual and evaluate what it can do. Crud, throw in a faster processor, a little more memory and a 4G antenna and I’d use it. The PEG-NZ90 was introduced by Sony in 2003.
    • imageI don’t pay much attention to retail pharmacy, but have you ever seen the ClearRx bottle and labeling system from Target? Brilliant, simply brilliant. Pharmacy bottles have been the same basic design for a long, long time. I applaud Target for doing something different. I still don’t like retail pharmacy, but I think their bottle design is cool.
    • I started using the Cloudring service. I use a lot of cloud-based storage solutions and Cloudring helps me keep certain files synched up between them. It also allows me to easily see all my cloud storage solutions at the same time and move files back and forth. So far I’ve experimented with Dropbox, Google Docs, Box and Evernote. It’s very cool.
    • The Barcode News: “Imagine, instead of a cashier having to handle every item in your cart, or you having to play spin the bottle with your ketchup at the self-checkout, you simply place your items on a conveyor belt where they are automatically scanned by the time they get to the bagging station. This is possible with 360 scanners. As the name denotes, 360 scanners are capable of scanning a product bar code from 360 degrees.” – Yeah, now instead of thinking of these things in grocery stores, think of using them in healthcare so people don’t have to actively scan things.
    • EHR Bloggers: “As part of the treatment plan for a patient who has a critical need to take one or more pills at or very near specified times throughout the day a physician, nurse or perhaps a new kind of specialist will develop a tracking plan.” – Stalker anyone? Just sayin’.
    • I read a lot of articles at the sciencebase website. They make reading about science fun and interesting. Even though it’s not from this week, I love the blurb they did on the shape of snowflakes. “Snowflakes have at their heart a minute grain of dust that was once floating in a cloud, this speck of dust is the nucleation centre around which water vapour from the atmosphere can condense and if it is cold enough crystallise as ice. As with any crystallisation process it follows a symmetry intrinsic to the atoms or molecules from which the crystal is formed. In the case of water, the underlying symmetry is hexagonal symmetry.” Be sure to watch the video on the site that shows some great snowflake images. Beautiful stuff.
    • How much work goes into movie poster design? Too much. Fast Company has an interesting article on The Psychology Behind Movie Poster Designs. It’s interesting to note that I never see a movie based on the poster design. Do you? I typically watch a movie based on whether or not I think it will entertain me. I don’t see a movie for artistic value, or views on “reality”, or political statements, etc. I go to be entertained. I go to escape reality for a couple of hours.
    • Snowboarding at night wearing an LED suite. Quite beautiful.

     

    • AJHP March 1, 2012 vol. 69 no. 5 405-421 “ Projecting future drug expenditures – 2012”: “For 2012, we project a 3–5% increase in total drug expenditures across all settings, a 5–7% increase in expenditures for clinic-administered drugs, and a 0–2% increase in hospital drug expenditures.” – Why is this important? Because acute care pharmacy budgets can run over $100 Million a year, that’s why.
    • Scientists have conducted the first successful human test with a drug delivery chip. The article appeared in Science Translational Medicine where the authors describes the successful use of a programmable chip loaded with medication and injected into a person. The chip holds several doses of the drug in place until an electrical current is applied, then the drug is released in the quantity specified. I worked on something like this when I was an undergraduate studying chemistry. Of course it was only in a beaker and not using drugs, but I used polyaniline to carry specific molecular entities and release them when current was applied. In our case, it was all or none, but it was cool. I still have my lab books from the experiments. 
    • Picked up a Samsung Galaxy Player 5.0 this week. I love the screen on this thing. Yeah, it’s big, but it’s beautiful. I already synched it with my Google account, which means I instantly had access to all my documents, my music, and of course my email. I also took some time to watch a little Netflix on it and listen to some music via it’s build in FM radio. I plan to take it with me to HIMSS12 along with all my other tech “stuff”. Deciding which of my toys to take on trips is becoming more difficult by the day. 

    That’s it folks. I think I’ll keep it short and sweet this week. Enjoy your weekend everyone, and remember “one of the symptoms of an approaching nervous breakdown is the belief that one’s work is terribly important” (Bertrand Russell).

  • ADR death statistics for the US, 1999-2006 [article]

    Here’s an interesting article from the February 2012 issue of The Annals of Pharmacotherpy [Adverse Drug Reaction Deaths Reported in United States Vital Statistics, 1999-2006].1 The most commonly involved drug classes are no big surprise, but it was interesting to note that the incidence of ADR death changed with age, race, and urbanization. I suppose the increase in death rate for ADR with increased age and rural living isn’t that big of a surprise, but the differences among sex and race was unexpected. 

    ABSTRACT

    Current Issue Cover

    Background: Adverse drug reactions (ADRs) are an important source of morbidity and mortality during medical care.
    Objective: To examine the trends in mortality related to ADRs reported through the US vital statistics system since January 1999.
    Methods: Demographic characteristics of people reported as dying as a result of ADRs from 1999 to 2006 were evaluated. The National Mortality Statistics database was queried for International Classification of Diseases, Tenth Revision, codes Y40-Y59, which are specific for deaths due to adverse effects of drugs in therapeutic use. The data were subgrouped based on demographic factors to identify important trends. Crude rates were calculated based on incidents per 100,000 population. Odds ratios and 95% confidence intervals for subgroups were calculated by logistical regression.
    Results: During the 8-year study period 2,313,902,748 person years were evaluated and 2341 ADR-related deaths were identified. Annual rates ranged from 0.08/100,000 to 0.12/100,000, and rates increased significantly over time at a rate of 0.0058 per year. ADR deaths were significantly more likely in persons older than 55 years. The risk was greatest in those aged 75 years or older (OR 6.96, 95% CI 6.30 to 7.69). ADR deaths were higher among men than women. Rates varied by race and ethnicity and were highest among blacks (OR 1.38, 95% CI 1.23 to 1.54). Geographically, rates varied widely between states. Based on urbanization, rates were highest in extremely rural (non-core) areas (OR 2.05, 95% CI 1.76 to 2.38). The most common drug classes associated with death were anticoagulants, opioids, and immunosuppressants.
    CONCLUSIONS: ADR death rates have a clear association with age, race, and urbanization subgroups. Older individuals, males, blacks, and individuals residing in extremely rural areas experienced higher ADR death rates; these findings warrant further study to develop prevention strategies.

    1. Ann Pharmacother February 2012 vol. 46 no. 2 169-175

  • RFID-initiated workflow control [article]

    RFID-initiated workflow control to facilitate patient safety and utilization efficiency in operation theater1

    Abstract
    Objective
    To control the workflow for surgical patients, we in-cooperate radio-frequency identification (RFID) technology to develop a Patient Advancement Monitoring System (PAMS) in operation theater.
    Methods
    The web-based PAMS is designed to monitor the whole workflow for the handling of surgical patients. The system integrates multiple data entry ports Across the multi-functional surgical teams. Data are entered into the system through RFID, bar code, palm digital assistance (PDA), ultra-mobile personal computer (UMPC), or traditional keyboard at designated checkpoints. Active radio-frequency identification (RFID) tag can initiate data demonstration on the computer screens upon a patient’s arrival at any particular checkpoint along the advancement pathway.
    Results
    The PAMS can manage the progress of operations, patient localization, identity verification, and peri-operative care. The workflow monitoring provides caregivers’ instant information sharing to enhance management efficiency.
    Conclusion
    RFID-initiate surgical workflow control is valuable to meet the safety, quality, efficiency requirements in operation theater.

    I like the concept that the article presents, but take a look in the methods section and note the presence of “palm digital assistance (PDA)”. That made me a little suspicious about the age of the article. Even though it was published in December 2011, it was received by the journal December 4, 2009; received in revised form August 16, 2010; accepted August 27, 2010 and finally published more than a year later in December 2011. So it took two years from the time the article was received until it was published. This just fuels my opinion that methods used to disseminate medical and scientific information is completely outdated.

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    1. Computer Methods and Programs in Biomedicine Vol. 104, Issue 3, Pages 435-442, December 2011