Jerry Fahrni

Tag: Pharmacy Practice

  • RFID tracking of refrigerated meds in the pharmacy

    I don’t understand why RFID technology isn’t used more frequently in pharmacies. I’ve talked with a few people about RFID technology, and there’s really not much interest. It’s a shame really.

    Consider this:
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  • Prenteral nutrition error [from #ISMP]

    From the latest ISMP Medication Safety Alert!, a mix up between an adult parenteral nutrition (PN) template in an electronic health record (#EHR) and one for pediatrics.

    The big difference between these two is how you order electrolytes; it’s a really big difference.

    The most shocking part of all this was that the error made it’s way through the physician that ordered it, a pharmacist that “entered the PN order” (I’m assuming in the compounding application), the “trained technician” that prepared it – missing the fact that the bag contained a whooping 2600mL of sterile water, the pharmacist that checked it, and finally the nurse that hung it. Swiss cheese anyone?
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  • Maximum effort and repetitive tasks [Article]

    I thought this was interesting as the objective of the effort was to “develop an equation, for repetitive tasks, that uses frequency and/or duty cycle (DC) to predict maximum acceptable efforts (MAE) relative to maximum voluntary efforts (MVE).”

    Huh? Exactly.

    I found this at CafeErgo:
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  • Warning labels on outpatient prescription vials not so great after all

    Everyone has seen them, I know you have. Those little colored labels that the pharmacy slaps on your bottle when you get a prescription: “May cause drowsiness”, “Avoid excess sun”, “Do not take aspirin products without doctor approval” and so on. There are a ton of them. I remember seeing them lined up in front of me when I was working retail. Sometimes it became a game to see how many you could fit on the bottle without covering up valuable information for the patient. I’ve also been in pharmacies where the warning labels were simply printed alongside the medication label.

    Well, it appears that this tradition may not be the best way to warn patients about potential issues with their medication. I mean, who really reads those things anyway?

    A small study recently published in the journal PLoS ONE took a look at these warning labels and determined that people really don’t pay attention. Not surprising.
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  • I have seen the end of operational pharmacists in long term care (#LTC)

    I spent Saturday, Sunday and Monday in Baltimore, MD at the ASHP Summer Meeting (#ashpsm). I was there for work, and didn’t have an opportunity to participate in any of the sessions. I did however get the opportunity to visit a large long term care pharmacy called Remedi SeniorCare just outside the city. This particular pharmacy is using Paxit robots to handle the dispensing needs for well over 10,000 long term care beds throughout the area.

    I am not a fan of robots in general, but I couldn’t help but be impressed with Paxit. The design is groundbreaking, genius and game changing for long-term care pharmacists. My initial impressions were’t exactly flattering, but after watching it run for the better part of an hour, and listening to the owner talk about it, my opinion changed.

    During part of the conversation our tour guide said that the company was able to “lay off five pharmacists” after getting the Paxit machines up and running. My gut reaction was one of anger. Who the heck do they think they are to get rid of pharmacists in a pharmacy! After all, I’m a pharmacist and no machine can replace me. Right? Wrong. Paxit does a fine job of replacing pharmacists in their traditional dispensing role. And it doesn’t make mistakes, it doesn’t get tired, it doesn’t whine about working conditions, it doesn’t show up late or call in sick, it doesn’t need benefits, etc, etc. No, the Paxit robot makes perfect sense in this environment both from a business standpoint as well as a safety standpoint; they’ve been filling prescriptions with Paxit for three years and it hasn’t committed a single dispensing error. I wish I had had such a safety record when I was still a real pharmacist.

    After my initial reaction I realized that the fault lies with ourselves, i.e. pharmacy practice itself. It’s our own fault. We’ve created a system where we can be replaced by a machine under the right circumstances. Anyone that’s been in pharmacy for any length of time could have told you this was coming, but we haven’t done anything to stop it. And by stop it I mean change our practice. I worked in an LTC pharmacy for nearly two years. It’s brain-numbing work. There’s very little need for a highly trained clinician in an LTC pharmacy. You certainly don’t need a highly trained clinician to check bingo cards or make sure all the right pills are in a med drawer. If you think you do, then you’re wrong. Dead wrong.

    Listen up all you pharmacists stuck behind the counter in retail pharmacies or sitting in the “main pharmacy” in a hospital dutifully counting meds as they go out the door. Continuing down the current path of pharmacy distribution is like putting a gun to the head of your pharmacy career. It’s only a matter of time before you’re obsolete, and it won’t be anyone’s fault but your own. It won’t matter for me as the change is probably still 20 years away, but for those of you just starting a new career “in pharmacy”, you should be looking over your shoulder.

  • 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.”

  • Pharmacy student adherence to a simulated medication regimen

    A Tweet from Anthony Cox (@drarcox) led me to this article in the American Journal of Pharmaceutical Education.

    In this study, 72 second-year pharmacy students were given “medications” (Starburst JellyBeans) to take with varying administration schedules. The table below shows the results of the little experiment, and it speaks volumes.

    Not surprisingly a “once daily” regimen was the easiest to follow, but still resulted in more than 10% of the doeses being missed. As the regimens grew in complexity, the percentage of missed doses increased.

    We did a similar experiment with M&M’s when I was a pharmacy student at UCSF. The results were similar, i.e. the more complex the regimen, the harder it was to adhere.

    Oh, and these were pharmacy students we’re talking about here. What do you think happens when you ask the average non-healthcare professional to adhere to a medication regimen?

    The entire article is available for free here.

  • Thinking about pharmacy refrigerators

    I love the Yanko Design website. It has so many cool concepts. Recently while browsing the site I cam across the Grabit, “a door handle fitted with a fingerprint scanner” (image to the right). I immediately thought of pharmacy. It would be cool to see one of these attached to all the refrigerators in the pharmacy. Anytime you wanted to get something out of the fridge you’d simply place your thumb on the fingerprint scanner as you grabbed the handle to open the door. The Grabit handle would register your fingerprint and identify you as someone that had access. And if not, you wouldn’t be able to get in. This would work well for high dollar items that you wanted to track or controlled substances that require refrigeration.
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  • Pharmacy technician program standards draft from ASHP now available for comment

    This was part of my ASHP NewsLink today - A draft of the updated, revised “Accreditation Standards for Pharmacy Technician Education and Training Programs” [from ASHP] is now available for comment until September 28. After this date, another draft will be developed and made available for one more round of comments.

    According to the document “the role of the pharmacy technician is evolving and varies according to state and setting. This role description draws on the one developed by the Pharmacy Technician Educators Council (PTEC)”, and the standards have been developed to:

    • protect the public,
    • serve as a guide for pharmacy technician education and training program development,
    • provide criteria for the evaluation of new and established programs, and
    • promote continuous improvement of established programs.

    You can see the actual document here.

    Kind of cool, except for the fact that the comment period is open until September followed by another round of comments. At this rate we should have a nice set of standards by the end of… uh…hmm, 2013? Woohoo! Light speed ahead.

  • Article: A pharmacist-led information technology intervention for medication errors (PINCER)

    From a recent article in The Lancet (The Lancet, Volume 379, Issue 9823, Pages 1310 – 1319, 7 April 2012)

    Kind of man versus machine study. Actually, it was more like man plus machine versus machine alone.

    “The control group practices therefore used simple feedback; after collection of data at baseline, control practices received computerised feedback for patients identified as at risk from potentially hazardous prescripting and inadequate blood-test monitoring of medicines plus brief written educational materials explaining the importance of each type of error. Practices were asked to introduce changes they considered necessary within 12 weeks after the collection of data at baseline. Intervention practices received simple feedback plus a pharmacist-led information technology complex intervention (PINCER) lasting 12 weeks.”
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