Jerry Fahrni

Tag: Patient Safety

  • Surprise! Pharma says their “digital resources” are good for consumers

    Sirensong

    Reliance on pharma-sponsored digital resources among online U.S. adults is significant. The research found “51% of online U.S. adults (ages 18+) use pharma-sponsored digital resources, such as condition and treatment information, disease management tools, doctor discussion guides, or mobile apps or websites.” This validates that the interactive information and tools produced by biopharma are being utilized and appreciated.

    Use of these materials results in action: a conversation about a prescription drug. The study learned “43% of consumers using pharma-sponsored digital resources have discussed prescription drugs with a doctor, nurse, or pharmacist as a result.” This data point supports the business objective behind providing these interactive resources: generating a conversation with a healthcare professional. Note that the study was fielded online among 6,634 U.S. adults, ages 18+ during Q4 2011.

    For comparison, Prevention Magazine’s Direct to Consumer Study 2011 found that as a result of seeing an advertisement – not necessarily online – 77% of survey respondents talked to a doctor and 23% asked for a prescription.

    How scary is this! Getting consumers to talk about their medication with their physician is a good thing; talking with their pharmacist even better. However, many times this type of advertising (“digital resource”) results in consumers asking about something completely inappropriate. Which, as we all know, can lead to  a physician prescribing an unnecessary medication, using something that they’re not familiar with or prescribing something they wouldn’t consider first line.

    All you have to do is look at the top 5 “patient and caregiver groups to agree that pharma should be involved in online health consumer communities” to understand why this is such a bad idea.

    1. ADD/ADHD Caregivers
    2. Bipolar Disorder Caregivers
    3. Epilepsy Caregivers
    4. Cystic Fibrosis Patients
    5. Rheumatoid Arthritis Patients

    Yikes! Choosing drug therapy is quite a bit different than picking out a book on Amazon and it should be treated that way.

  • Don’t confuse Durezol and Durasal (S.A.L.A.D.)

    PharmQD: “FDA is alerting pharmacists and other health care professionals of potential injury due to confusion between the FDA-approved eye medicine Durezol (difluprednate ophthalmic emulsion) 0.05% and the unapproved prescription topical wart remover Durasal (salicylic acid) 26%.

    There has been one report of serious injury when a pharmacist mistakenly gave an eye surgery patient Durasal, the salicylic acid–containing wart remover, instead of the prescribed Durezol eye drops. Durezol is approved for treatment of inflammation and pain association with ocular surgery.”

    Seems like I’ve read about this mistake before. Being their typical efficient self, the FDA alert was issued on December 28, 2011, more than three months after ISMP alerted everyone.

    Some things you can do to prevent stuff like this from happening include (taken from a Pharmacy Times article):

    • Include both brand and generic names, along with indication, when prescribing look- or sound-alike drug names.
    • Spell out drug names that have been confused when accepting telephone orders. Require staff to write down the prescription and then perform a read back (and spell back for drugs that are known to cause confusion) of the complete prescription for verification.
    • Assign time to provide counseling to patients and/or caregivers, especially for new prescriptions.

     

  • DrugCite, a searchable database of drug side effects reported to the FDA

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  • High-Alert Medications Involved in Wrong-Drug Errors [Article]

    A recent article in Pharmacy Times outlines some interesting examples of Sound-Alike-Look-Alike-Drugs (SALAD) causing trouble in pharmacy. We’ve all seen them, and I’ve blogged about them before. Hydralazine and hydroxyzine represent a prototypical SALAD pair, but there are many others out there; ISMP’s list can be found here (PDF).
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  • Prevalence of medication administration errors in two medical units with automated prescription and dispensing [Article]

    From the Journal of the American Medical Informatics Association1. I was a little shocked by the number of errors, but as you can see in the abstract below, and in the title, the errors were during the administration phase of the medication use process. Seems a bit odd to look at medication errors during administration when talking about automated prescribing and dispensing. I’m sure there is an explanation in the full article. However that requires a subscription. Interesting nonetheless:

    Abstract
    Objective     To identify the frequency of medication administration errors and their potential risk factors in units using a computerized prescription order entry program and profiled automated dispensing cabinets.

    Design Prospective observational study conducted within two clinical units of the Gastroenterology Department in a 1537-bed tertiary teaching hospital in Madrid (Spain).

    Measurements Medication errors were measured using the disguised observation technique. Types of medication errors and their potential severity were described. The correlation between potential risk factors and medication errors was studied to identify potential causes.

    Results In total, 2314 medication administrations to 73 patients were observed: 509 errors were recorded (22.0%)—68 (13.4%) in preparation and 441 (86.6%) in administration. The most frequent errors were use of wrong administration techniques (especially concerning food intake (13.9%)), wrong reconstitution/dilution (1.7%), omission (1.4%), and wrong infusion speed (1.2%). Errors were classified as no damage (95.7%), no damage but monitoring required (2.3%), and temporary damage (0.4%). Potential clinical severity could not be assessed in 1.6% of cases. The potential risk factors morning shift, evening shift, Anatomical Therapeutic Chemical medication class antacids, prokinetics, antibiotics and immunosuppressants, oral administration, and intravenous administration were associated with a higher risk of administration errors. No association was found with variables related to understaffing or nurse’s experience.

    Conclusions Medication administration errors persist in units with automated prescription and dispensing. We identified a need to improve nurses’ working procedures and to implement a Clinical Decision Support tool that generates recommendations about scheduling according to dietary restrictions, preparation of medication before parenteral administration, and adequate infusion rates.

    1. J Am Med Inform Assoc. 2012 Jan 1;19(1):72-8. Epub 2011 Sep 2.

  • GPhA reveals the ARI to address drug shortages

    Did you know there was a Generic Pharmaceutical Association (GPhA)? Well, if you did you’re a step ahead of me because I’d never heard of them until today. According to the GPhA website they represent "the manufacturers and distributors of finished generic pharmaceutical products, manufacturers and distributors of bulk active pharmaceutical chemicals, and suppliers of other goods and services to the generic pharmaceutical industry. GPhA members manufacture the vast majority of all affordable pharmaceuticals dispensed in the United States. Our products are used in nearly two billion prescriptions every year."

    Their Board of Director’s and Executive Committee is a who’s who of generic pharmaceutical manufacturers. Go figure.

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  • Wanna’ tell the FDA about drug shortages? Here’s how

    Here’s the contents of a email I received today from ASHP in regards to drug shortages and the FDA:

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    The Food and Drug Administration Wants to Hear How Drug Shortages Impact Patients

    The Food and Drug Administration has opened a comment period to gain insight about the causes and impact of drug shortages. The agency is seeking feedback as a follow up to a public workshop on the impact of shortages.

    You know first-hand the devastating effect that drug shortages are having on patient care.  Today, ASHP’s Drug Shortages Resource Center lists 208 shortages. That’s nearly the same number of shortages that were reported in all of 2010.

    This is your chance to speak up.

    Write a letter to the FDA that describes your experiences and challenges managing drug shortages.  Here’s what you should include:

    • Impact on patient care.  Share examples from your practice site, such as patients who’ve had to delay care or who’ve experienced adverse affects from second-line therapies.

    • Impact on pharmacy department operations: Discuss how the time spent researching availability of drug products and the redeployment of pharmacists from patient care roles affects the pharmacy department.

    Be sure to ask your colleagues in the pharmacy department as well as your nursing and physician colleagues to join you. Enlist your patients as well. Every voice counts!

    The deadline to submit comments is December 23, 2011. You can post comments on www.regulations.gov or send comments to the Division of Dockets Management (HFA-305), Food and Drug Administration, 5630 Fishers Lane, Rm.1061, Rockville, MD 20852.  See the Federal Register notice for more details.

    Your input and expertise are not only welcome, they are essential to achieving a solution to this critical issue.

    Use the resources below to familiarize yourself with ASHP’s messages on drug shortages.

  • Fun with Lugol’s solution…not really

    A recent ISMP Medication Safety Alert shared various errors that have occurred with Lugol’s solution over the ages. Lugol’s solution is a concentrated liquid form of potassium iodide and iodine known for its use in the treatment of hyperthyroidism. It’s also a dangerous drug because it’s typically dosed in drops, not mL’s.

    Anyway, the ISMP alert shared several examples of oral overdoses with Lugol’s solution secondary to confusion between drops and mL’s. However, mixed in with all the “typical” errors, was the little gem below. Even though the error is more than a decade old, I can’t help but wonder “what the heck were they thinking!”. By the way, my initial read through had me thinking cursive “OS” (oculus sinister, i.e. LEFT eye). With that said, I wouldn’t have actually dispensed it because nothing else on the prescription fits.

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    One of the errors reported more than a decade ago involved an order to administer 10 drops of Lugol’s solution mixed with "OJ" (orange juice), but nurses misinterpreted "OJ" as OD (right eye). The patient received several doses of Lugol’s solution in his right eye. The error was identified when the patient complained to the physician about how painful the eye drops were.

  • Accurate Assessment of Adherence (man vs. machine) [abstract]

    A recent article in Chest1 demonstrates the value of electronic data collection in medication adherence. In this case it was inhalation therapy in cystic fibrosis patients. This type of article is important as we consider the future of electronic health records and where the data for such records should come. Remember, people are notoriously unreliable historians while computers don’t lie.

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  • Cool Pharmacy Technology–RevVac Syringe

    I suppose this could really be cool tech for nursing or lab, but I thought it was worth having a deeper look.

    The ReVac Retracting Safety Syring by Revolutions Medical “use a proprietary patented technology in which a vacuum causes the needle to retract into the barrel of the syringe or device after an injection is administered or blood is drawn.”

    According to the Revolutions Medical website “[t]he RevVac™ Safety Syringe and Phlebotomy (blood drawing) Device operate the same as a standard syringe and device. No additional training, skills, or procedures are necessary. The both products work on a vacuum principle, where pressing the plunger in them creates a vacuum. When the plunger reaches the bottom, the needle is captured. A further push on the plunger breaks the seal, and the needle retracts into the plunger barrel. The vacuum is maintained, so the needle cannot be removed from the plunger.”