Jerry Fahrni

Tag: Pharmacy Practice

  • Augmented reality has potential for use in pharmacy

    Augmented reality has been a standard of science fiction for decades, but now it’s a reality. We all remember the Starbucks app that made the Red Holiday Cup come to life last year, right? If not here’s a video on YouTube. Of course that’s just the tip of the iceberg as Google and Microsoft have both started playing with the concept; Google with Project Glass and Microsoft by filing a patient with the U.S. Patent and Trademark Office for “event augmentation with real-time information” last year. Google’s Project Glass was even named one of 2012’s best inventions by TIME.

    Setting aside the marketing hype for such things for a minute consider the practical uses in pharmacy practice for something like Google’s Project Glass. Imagine two similar, but distinctly different scenarios:
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  • Saturday morning coffee [December 8 2012]

    So 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 comes from Jason DeVillains, better known to many as The Cynical Pharmacist. Jason and I met via Twitter (@TheCynicalRPH) and have been chitchatting via the web ever since. I mentioned that I was running low on coffee mugs and he decided to help me remedy the problem by sending me four of them. When my daughter and I opened the box this particular mug made her laugh, so I felt that it only fitting that it be the first one to make an appearance online. Jason also has a blog aptly called The Cynical Pharmacist, where he talks about all kinds of stuff; some healthcare related, some not. He has an interesting blogging style where he makes good use of video clips. Check it out.

    The Twilight Saga: Breaking Dawn: Part 2 was #1 at the box office last weekend pulling in just about $17.5 Million. Skyfall was a close second with $16.5 Million. That says something about the quality of Skyfall as it continues to draw big crowds even after being out for four weeks.
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  • What the NECC fiasco means for automation in pharmacy IV rooms

    According to the CDC website, the fungal meningitis outbreak linked to a tainted batch of steroid injections made by the New England Compounding Center in Framingham, Massachusetts has resulted in more than 500 case reports and 36 deaths (as of November 28, 2012).

    A lot of things happen when something like this occurs. People become fearful, regulatory agencies begin to scrutinize processes and practices, organizations like ASHP begin to formulate statements and create plans to deal with questions and backlash, healthcare systems begin to reconsider how they do things, and people begin to change the way they think. It’s a natural progression. I’ve seen it happen more than once during my career; never to this extent, but I’ve seen it before. It typically leads to practice changes and an entirely new market for consultants.

    The NECC case has caused quite a stir in the pharmacy community. I’ve seen a wild swing in topics of discussion among pharmacists in the acute care setting, i.e. hospitals. Two things in particular have caught my attention: 1) all of a sudden everyone is worried about compounding safety in the IV room, and 2) everyone is talking about robotics. I’ve talked to a couple of friends that are still practicing pharmacy and they are “in the process of looking at IV robots”. Both cited NECC as the reason for their new interest in robotics.
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  • Health Robotics ASHP Midyear press release includes mention of RFID

    I came across this press release yesterday. The press release is from Health Robotics, a company that builds and distributes automation and technology aimed squarely at the I.V. room. Their product line includes several robots designed for specialized I.V. room compounding, including i.v.STATION ONCO, i.v.STATION, CytoCare and TPNstation.

    It looks like the company is taking advantage of recent events surrounding sterile I.V. preparation to promote the safety of robotic compounding. They will be presenting data from recent studies from various hospitals across U.S. This all makes sense. But what I found interesting was the quote from Gaspar DeViedma, Health Robotics’ EVP.

    “… I invite all ASHP attendees to compare and contrast our company’s track record now yielding streamlined robotic “live” installations within 60 to 90 days from purchase order; new RFID solutions tracking temperature-controlled I.V. doses from the offsite sterile compounding sites to the hospital pharmacies, on to delivery carts and refrigerated cabinets and all the way to the patient; and finally to witness the new standards in Chemotherapy and Monoclonal Antibody Therapy IV Automation.”

    The emphasis is mine. That part about RFID almost slipped past me when I first read it. RFID is gaining popularity in the pharmacy world. Health Robotics certainly has my attention. I’m curious to see what they’re up to. I hope to have an opportunity to visit their booth at Midyear. I’ll keep you posted.

  • Transforming pharmacy technicians for the future

    I support the use of pharmacy technicians in many roles inside acute care pharmacies. I believe that they are a valuable tool and, when properly utilized, pharmacy technicians can not only improve pharmacy operations and patient safety, but can also give pharmacists freedom to focus on clinical duties and patient care.

    This is why I found a recent article in Pharmacy Practice News so interesting. The article describes a program at Inova Alexandria Hospital in Alexandria, Virginia where the department of pharmacy has developed a system to educate their technicians for expanded roles.

    The program outlined in the article is quite extensive and involved. Why would Inova Alexandria Hospital undertake such a task? It’s simple really. As stated in the article: “The implementation of automation means expanded roles for technicians. Automation promotes safety and accuracy, and when used properly, it can save valuable time, freeing up technicians to work in other areas of patient care and enabling pharmacists to act as direct care providers. The American Society of Health-System Pharmacists’ (ASHP) Pharmacy Practice Model Initiative cites technicians as a cornerstone of the future of pharmacy practice and recommends increased educational requirements for technicians in the future.” I couldn’t agree more.

    The program consists of monthly sessions targeted at educating technicians about medications and disease states. It is designed to promote interactive discussion and teamwork, and appears to have paid off in spades for Inova. According to the article, “The benefits of the technician education forum are numerous. Technicians have become more engaged and accountable for their work and have reported an increased job satisfaction. Furthermore, teaching technicians about correct dosing and safety allows them to become a second set of eyes for pharmacists. Technicians present concerns or questions during daily activities based on topics and concepts previously presented.”

    The article presents examples of how to present clinical information to technicians, and even includes a chart for tips on starting a technician education program of your own. It’s a great article and I encourage everyone involved in pharmacy to take a few minutes to read it.

    The future of pharmacy remains uncertain, but it is clear that technicians are an underutilized commodity in acute care pharmacy. Expanding the role of pharmacy technicians can only improve pharmacy practice and serve as a springboard to launch pharmacist into more patient centric activities.

    cross-posted at Talyst.com

  • Improving medication safety with accurate medication lists and education [article]

    Here’s an interesting article in the October 2012 issue of Joint Commission Journal on Quality and Safety. The article looks at the impact of pharmacy involvement in the medication reconciliation process. In this “study” pharmacy was involved in ensuring an accurate medication list as well as following up with patients after discharge to “enhance patient safety”.

    Overall the results appear positive: improved accuracy of pre-admission medication lists, reduction in medication errors, reduction in 30- and 60-day readmission, and reduction in ADEs associated with readmission and ED visits.

    I only have two minor complaints about the article. First, the data is old. It’s good information, but the impact is diluted by the fact that it was collected nearly 2 years ago. And second, you have to have a subscription to read the entire article, or be willing to shell out $20 to download the full text. Information like this should be open access.

  • Pharmacists’ Recommendations to Improve Care Transitions [article]

    No big surprise here. An study that used pharmacists to “[provide] perspectives on admission and discharge medication reconciliation, in-hospital patient counseling, provision of simple medication adherence aids (eg, pill box, illustrated daily medication schedule), and telephone follow-up” found that “pharmacists are well positioned to participate in hospital-based medication reconciliation, identify patients with poor medication understanding or adherence, and provide tailored patient counseling to improve transitions of care“. Makes sense, don’t you think? After all, that’s what pharmacist do. They deal with medications. All things to do with medications, which includes medication reconciliation.

    When I was in pharmacy school at UCSF fourth year pharmacy students were responsible for medication reconciliation. Each “general medicine” team had a fourth year pharmacy student on it, and when there was a new admission the student would interview the patient and reconcile their medication lists. Then we’d simply place the reconciled list in the chart for the attending. When it was time for discharge we’d do it all over again. Often times we’d go as far as to get the discharge prescriptions filled at the outpatient pharmacy and deliver them to the patient bedside where we would provide consultation and education before the patient went home. Pretty cool stuff. This is how it should be done at every hospital. Just sayin’.

  • Tight glycemic control has no proven benefits for children in the cardiac ICU [article]

    It looks like we’re still beating this dead horse. I thought we put the tight glycemic control issue to bed a while back. Then again I’ve been out of the game for quite some time, so it’s quite possible that I’ve missed something. Actually, it’s likely I’ve missed something.

    Tight glycemic control was all the rage in intensive care units (ICUs) all over the country in the late 90’s early 2000’s. Tight control was supposed to reduce infection, promote healing, improve outcomes, etc. Then we found out that tight control really didn’t do that, but it did cause a lot of adverse effects, namely severe hypoglycemia. Makes sense when you thing about it. Giving patient aggressive insulin infusions to keep blood glucose less than 110 mg per deciliter is bound to lead you down the path to hypoglycemia. Just sayin’.

    Every once in a while a new study shows up looking at tight glycemic control in the ICU. The most recent is a study in children. The nuts and bolts of the study? Basically there was no indication that tight blood glucose control showed any benefit in pediatric patients undergoing heart surgery. The results are from the Safe Pediatric Euglycemia in Cardiac Surgery (SPECS) trial, which was conducted at Boston Children’s and at the University of Michigan C.S. Mott Children’s Hospital. The full article appears in the September 7 online edition of the New England Journal of Medicine. It’s free to read, so I would encourage you to get it while you can. The article should be available in the September 27 print edition as well.

    SPECS examined tight glycemic control with insulin compared to standard glucose management in 980 children hospitalized in the cardiac intensive care unit (CICU). Results from the research showed that maintaining “normal” blood glucose levels [80 to 100 mg per deciliter] with insulin had no demonstrable impact on the incidence of care-related infections (such as surgical site infections and pneumonia), length of stay in the CICU, organ failure or mortality. And as expected, the glycemic-control group had a higher rate of severe hypoglycemia (<40 mg per deciliter) than did the standard-care group; 3% versus 1%, respectively. The rate of total hypoglycemia (<60 mg per deciliter) followed a similar pattern; 19% for the glycemic-control group versus 9% for the standard-care group.  Not surprising.

    Hey, it wasn’t all for nothing. The primary author of the article, Dr. Michael Agus had this to say, “There were two successes for this trial. One was that we were able to show that children and adults are different when it comes to the benefit of glucose control in an CICU. We were also able to demonstrate that we can safely control glucose in a young, vulnerable, sick population.” And there you have it, children are not adults and we can safely treat children under our care. Who knew.

     


  • Cool Pharmacy Tech – Fillmaster Plus

    I was talking with someone the other day about extemporaneous compounding and they mentioned FLAVORx. I like extemporaneous compounding and have been aware of FLAVORx for quite some time. In fact I featured it as a “Cool Technology for Pharmacy” back in February 2010.

    While I was at the FLAVORx website I came across a link to Fillmaster Plus made by Fillmaster Systems out of El Cajon, CA. The Fillmaster Plus is genius in its design because it’s simple, eloquent, makes use of current technology – barcode scanning, SD card, liquid pump, etc – and fits a niche.

    Fillmaster Systems is only a couple of hours from LA. Next time I’m down that way I should take an excursion to Fillmaster HQ and get a close-up look for myself. I wonder how they would handle a surprise visit.

  • 4 technologies every hospital pharmacy should be using right now

    There are lots of useful technologies out there for pharmacies, but I see precious few being put to good use. Why? Oh, who the heck knows. It’s a mystery to me. People whine all the time about how bad pharmacy operations are, but they never do anything to fix it. Human nature I suppose. If I were a DOP or CPO I’d be using anything and everything I could get my hands on to improve operations and make life easier for my pharmacists, and in turn easier for “pharmacy” and nursing, which in theory leads to better patient care. It’s the great circle of life. Sort of.

    Here are four things I think every hospital pharmacy should be using, in no particular order:
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