Jerry Fahrni

Tag: Pharmacy Practice

  • Saturday morning coffee [March 9 2013]

    MUG_genericSo much happens each and every week that it’s hard to keep up sometimes. Here are some of the tabs that are open in my browser this morning along with some random thoughts….

    The coffee mug to the right isn’t one of my personal mugs. Instead it’s the kind of generic mug you get in cheesy hotel restaurants. And that’s because I’m not at home. I’m in Las Vegas for my daughter’s volleyball tournament. In lieu of that, and the fact that I had to crawl off into a “quiet” corner to open my laptop, I’m going to make this quick.

    Jack the Giant Slayer was #1 at the box office last weekend. Not a big surprise as again there was little in the way of competition at the box office for a second week in a row. Jack brought in a measly $27 Million on its opening weekend. Not too bad, but when you consider the $195 Million production budget that makes it a flop. Yikes! My family and I saw Jack over the weekend. We enjoyed it. Identity Thief continues to do well as it came in second place for weekend box office totals.
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  • #1 thing to consider when buying pharmacy automation and/or technology…

    There are a ton of things to consider when you’re thinking about putting new technology in the pharmacy. You have to consider the cost, the impact on your operations, the reputation of the company that you’re buying from, what type of technology you’re going to buy, and so on and so forth ad infinitum.

    However, the number one thing you must consider before taking the plunge is whether or not the technology fits your dispensing model. Do you still do a cart fill? Are you completely decentralized? Are you using a just-in-time dispensing model? Will the technology that I’m looking at fit what I hope to accomplish? You need to think about that long and hard before making a decision.

    It’s like buying a new vehicle. You certainly don’t buy a Toyota Prius if you need to pull a 24 foot Centurion Enzo SV244 – a really nice boat – to the lake on weekends. No, instead you buy a new Ford Super Duty truck. I know that makes perfect sense to you, yet I hear people frequently say “it doesn’t fit the way we work” when talking about pharmacy automation and technology. When they say that, the first thing that pops into my mind is “then why did you buy it?”. It’s a question that needs serious consideration because some of this stuff is expensive.

    I experienced this firsthand in my previous role as an IT pharmacist. We installed new technology that didn’t really fit our distribution model all that well. We tried to cram the technology into an manual process. Didn’t work. I fought it for a few months until the light bulb finally went off. Once we got out act together we redesigned the process around the technology. We took advantage of the automation and filled in the gaps where necessary. It fundamentally changed the way we did things, and in the process improved the overall distribution process.

    So before you go and buy a robot, or a carousel, or a high-speed packager, or a compounding machine, make sure you ask yourself how you’re going to use it.  This stuff isn’t top secret. Do a quick Google search. Watch some videos. Talk with hospitals that do the same things as you.

    In a nutshell do your homework before taking the plunge because once you take the plunge and decide you’ve made a mistake you can only do one of two things: 1) change automation, or 2) change the way you work.

  • Patient collected information and the role of pharmacists

    I had an interesting phone conversation this morning with Kevin Sneed, Pharm.D.(@DeanSneed), Dean at the University of South Florida College of Pharmacy (USF COP). I’ve been trying to connect with Dr. Sneed for a while now, but as you can imagine his schedule is pretty full. Fortunately for me I was able to grab about 30 minutes of his time this morning. And what a great 30 minutes it was. I was so impressed with what he had to say that I’m planning to visit USF COP sometime in the next couple of months to continue the conversation and get a first hand look at what’s going on there.

    While I could expound on our conversation for several pages, one comment that Dr. Sneed made struck me as so profound that I thought I would quickly share it.

    During the conversation we started talking about data, and where it’s coming from. Pharmacy is a data driven science, but never has the data come from so many directions. Dr. Sneed commented that patients are taking control of information these days, and not only are they more informed, but they are generating much of the information that will be used in their care. Patients are becoming connected more and more. This is especially true with the advent of mobile technologies that wirelessly transmit tons of data for everything from exercise regimens, to weight, glucose readings, heart rate measurements, and so on. Dr. Sneed sees a future where patients will present this information not only to physicians, but other healthcare professionals such as pharmacists as well; it will be used as currency to start conversations and facilitate care. I’ve heard people in healthcare refer to data as currency before, but I never really made the connection until now.

    It’s clear that we’re in a new age of heatlchare, and pharmacists need to be prepared to collect this information and utilize it to provide better pharmaceutical care. This may sound superficial on the surface, but it is a very important point. Think of a time, not so far in the future, when pharmacists will have a lot more information about patients at their fingertips. This will likely occur across all pharmacy environments, i.e. outpatient, long term care, acute care, etc. This information will give pharmacists an ever increasing role in direct patient care.

    Something to think about as pharmacists prepare for a future healthcare model that is rich in information provided by their patients. Exciting opportunities lie ahead if we’re prepared to accept them.

  • Who should drive the selection of pharmacy automation and technology?

    Who should be the driving force behind the selection of new automation and technology in a hospital pharmacy? It’s a simple question really, and in my mind there’s only one clear answer: pharmacy should drive the selection of their own automation and technology. That makes sense, right? Well it certainly does to me.

    However, lately I’ve seen a disturbing trend when talking with hospital pharmacies about their selection process. It appears that the IT department – you know, those guys that configure computers and keep your network and hospital servers humming along – has been given a lot of authority in the selection process. Call me crazy, but that seems a little strange to me.

    I’ve always thought of IT as a service department, someone to help you accomplish your goal when it involves technology. As an IT pharmacist it was my job to look at pharmacy automation and technology, evaluate it, weigh the pros and cons, and make a decision based on what was best for the goals of the pharmacy. Once that was done I would get IT involved in the process to make sure we had everything we needed from not only the vendor, but our own hospital IT department as well. If there were gaps we would work together to flesh them out.

    What happens if the IT department is given the leeway to make a decision for the pharmacy on which automation and/or technology they should use? They might make the “right decision”, but if they did it would be the result of sheer dumb luck. The selection process should be one that looks to find the best fit for the pharmacy, one that fits into the pharmacy’s distribution model, one that lines up with existing technology, one that takes future pharmacy plans into consideration, one that will help drive pharmacists out of the pharmacy toward more clinical activities,  one that acknowledges the strengths and weaknesses of the vendor in terms of functionality, usability and support,  and so on. The decision should not be based on who uses the best security protocol, or who prefers Dell Servers over HP Severs, or whether or not the vendor needs network access for support or not, and so on and so forth.

    I truly feel sorry for healthcare systems that ignore their pharmacy personnel when thinking about purchasing new automation and technology for pharmacy operations. In my opinion it’s a recipe for disaster. I certainly wouldn’t want to work in a pharmacy where the tools I used were selected by someone who didn’t even know what I was working on. The next time you have the oil changed in your car, ask the mechanic if he would let the person that installed their computers pick out his tools. I bet you’ll get a similar response to mine, although the language may be a bit more colorful. Better yet, ask a software engineer if he’d let a pharmacist pick out the hardware and software necessary to do his job. It’s a safe bet that he’d look at you like you’d lost your mind.

  • Interview with Healthcare IS [audio]

    I was recently interviewed by Healthcare IS. The audio interview is only about 20 minutes long and covers me answering some general questions about pharmacy informatics, my thoughts on working as an IT pharmacist, etc.

  • Adding Pharmacists to Primary Care Teams Increases Guideline-Concordant Antiplatelet Use in Patients with Type 2 Diabetes [article]

    Here’s an interesting little tid-bit in the January issue of The Annals of Pharmacotherapy. According to the article “adding pharmacists to primary care teams significantly and substantially increased the proportion of type 2 diabetic patients using guideline-concordant antiplatelet therapy“. Good stuff to be sure. Unfortunately the study only looked at the proportion of patients using antiplatelet therapy at 1-year after engaging the pharmacist. It would be interesting to see data around decreased morbidity, hospital readmission rates, etc to go along with the improved guideline-concordance.

    Abstract

    BACKGROUND: Antiplatelet therapy is recommended as part of a strategy to reduce the risk of cardiovascular events in patients with type 2 diabetes. However, compliance with these guideline-recommended therapies appears to be less than ideal.

    OBJECTIVE: To assess the effect of adding pharmacists to primary care teams on initiation of guideline-concordant antiplatelet therapy in type 2 diabetic patients.

    METHODS: Prespecified secondary analysis of randomized trial data. In the main study, the pharmacist intervention included a complete medication history, limited physical examination, provision of guideline-concordant recommendations to the physician to optimize drug therapy, and 1-year follow-up. Controls received usual care without pharmacist interactions. Patients with an indication for antiplatelet therapy, but not using an antiplatelet drug at randomization were included in this substudy. The primary outcome was the proportion of patients using an antiplatelet drug at 1 year.

    RESULTS: At randomization, 257 of 260 study patients had guideline-concordant indications for antiplatelet therapy, but less than half (121; 47%) were using an antiplatelet drug. Overall, 136 patients met inclusion criteria for the substudy (71 intervention and 65 controls): 60% were women, with mean (SD) age 58.0 (11.9) years, diabetes duration 5.3 (6.0) years, and hemoglobin A1c 7.6% (1.5). Sixteen (12%) had established cardiovascular disease at enrollment. At 1 year, 43 (61%) intervention patients and 15 (23%) controls were using an antiplatelet drug (38% absolute difference; number needed to treat, 3; relative increase, 2.6; 95% CI 1.5-4.7; p < 0.001). Of these 58 patients, 52 (90%) were using aspirin 81 mg daily.

    CONCLUSIONS: Adding pharmacists to primary care teams significantly and substantially increased the proportion of type 2 diabetic patients using guideline-concordant antiplatelet therapy.

  • Quick review of things worth reading this week

    I missed my regular Saturday morning coffee post yesterday for a couple of reasons. I have a cold that has been kicking my butt all week. Not sure why this cold feels particularly weighty, but it does. Is it that I’m run down or that I’m aging? I pray that it’s the former, but fear that it is the latter. My good friends acetaminophen, antihistamine and decongestant have helped me through the week. Top that off with one of the worst travel weeks I can remember in a while and I’m ready for a day on the couch.

    Yesterday was a bit of a reprieve as I found myself in Los Angeles visiting my daughter and watching the UCLA men’s basketball team lose to Oregon in an exciting game. I would have preferred that UCLA won, but at least I had some downtime with my family and the weather in Los Angeles was spectacular.

    However, life goes on and there were at least a few things I read this week that are worth sharing:
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  • Pharmacy tabletop unit-dose packager comparison [table]

    Tabletop unit-dose packagers don’t get much respect, but have you ever been in a hospital pharmacy servicing more than 100 beds that doesn’t have one? I haven’t. Not to say that every pharmacy out there has one, but they’re certainly prevalent.

    The Cadet by Euclid is pretty much synonymous for “tabletop unit-dose packager” in the pharmacy world. It’s akin to how people use the term Xerox to refer to any copy machine, or iPod for any mp3 player. So don’t be surprised if someone refers to your tabletop unit as a “Euclid” regardless of which one you have.

    Anyway, I was doing a little research on the subject and thought I’d share my findings with you (table below). The one piece of data I don’t have is price; companies aren’t exactly transparent with that type of thing.
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  • The impact of prescription time guarantees on patient safety

    I came across an interesting article at the ISMP website this morning. The article details the results of a community pharmacy survey looking at what impact policies and procedures related to guaranteed prescription fill times have on medication errors. The results are predictable and scary.

    “Eighty-three percent of pharmacists working at pharmacies with advertised time guarantees reported that the time guarantee was a contributing factor to dispensing errors; almost half of them (49%) felt this contributing factor was significant. In fact, 44% of pharmacists working in pharmacies with time guarantees reported a dispensing error they were personally involved in, which was directly attributed to rushing to fulfill the time guarantee.”

    That right there is reason enough to not allow time guarantees when it come to filling a scripts.

    Read the rest of the article, especially the table of pharmacists’ perspective on time guarantees. It’s worth a few minutes of your time.

    Afterthought: Why do pharmacists continue to work in this environment? Do they like the work most of the time, and only hate it some of the time? I used to know a few pharmacists that worked in the retail sector of pharmacy, but they’ve all moved on. A couple went to work for PBM’s and two abandoned the profession altogether: one left pharmacy to become an accountant – he’s much happier these days – and another one just quit. I don’t know what she’s up to these days, but the last time we spoke she was dabbling in interior design.

  • IV room workflow management system comparison [table]

    There are basically four IV room workflow management systems that I’m aware of: DoseEdge by Baxa, Pharm-Q In The Hood by Envision Telepharmacy, SP Central Telepharmacy System by ScriptPro and Phocus Rx by Grifols. Here’s a little table I’ve put together comparing them based on what I know.

    Product

    DoseEdge

    Pharm-Q In The Hood

    SP Central Telepharmacy

    Phocus Rx System
    Popularity

    High

    Medium

    Low

    Low
    Hardware Stationary camera stand, remote workstation Stationary camera mounted on i.v. bar in hood, remote workstation Stationary camera stand, remote workstation Two compact 5 MP cameras mounted outside hood**New hood with integrated cameras and workstation
    Software SaaS model “IV Workload Management Solution”; photo capture; pharmacist work queue; barcode verification “Web-based”; photo capture; pharmacist work queue; video messaging Photo capture;  web-based pharmacist check queue Photo capture; bi-directional com; image capture; pharmacist check queue
    Acute Care Focus

    High

    Medium

    Low

    High
    Interesting features SaaS model; per-dose pricing;  barcode scanning; telepharmacy remote checking; SAS70 compliant hosting/storage site; automated volume calculations; kitting Telepharmacy remote checking;  video messaging between tech and pharmacist; patented camera for use in hood; multiple configurations Telepharmacy remote checking; integration with central pharmacy workflow system; “call button” for pharmacist interaction Camera mounted outside hood;  barcode scanning; pharmacist queue can be accessed via mobile device; configurable stage verification**New hood design with camera and workstation built into hood.
    Advantage(s) Head start in the market; market penetration; name recognition; Baxa backing (resources); photo capture; iv room specialty; Use of telepharmacy technology (have been doing telepharmacy for a while); camera design; photo capture Use of telepharmacy technology; name recognition (although not in AC) Unique camera feature; acute care focus; i.v. room specialists; only product with camera and workstation built directly into the hood**Integrated camera and monitor in hood
    Biggest Weakness Cost; no new features in a while Small; no market penetration Relative unknown in AC; poor online information and marketing Relative unknown product