Jerry Fahrni

Tag: Pharmacy Practice

  • 2012 ISMP Med Safety Self Assessment for Oncology now available

    The Institute for Safe Medication Practices (ISMP), ISMP Canada and the International Society of Oncology Pharmacy Practitioners, have launched the 2012 ISMP International Medication Safety Self Assessment for Oncology. The tool is used to “identify a baseline of oncology-related medication practices and opportunities for improvement.” ISMP is asking that any practice setting that administers chemotherapy get an interdisciplinary team together to go through the assessment; hospitals, ambulatory cancer centers, physician office practices, and so on. Once the assessment is completed the information can be submitted anonymously online through June 29, 2012.

    These self assessment tools are kind of cool. ISMP will aggregate the results and your facility can use the information as a measuring stick to compare your facility to others. The Oncology self assesssment tool can be accessed on the websites of all three organizations (www.ismp.org, www.ismpcanada.org, www.isopp.org).

    ISMP has other self assessment tools as well. You can see them all here.

    I went through the Automated Dispensing Cabinets and Bar Coding Assessments when I was still practicing as an Informatics Pharmacists. They’re quite helpful in jumpstarting the thought process.

  • Results from ISMP’s survey on IV storage and beyond use dating show confusion, lack of standards

    Beyond use dating (BUD) is a bit of a hassle in acute care practice. The reason is that regulatory bodies have muddied the water with information that isn’t always the most recent or evidence based. ISMP recently published information from a survey of 715 pharmacy professionals on drug storage, stability, and beyond use dating of injectable drugs, and the results are a bit disappointing. There’s clearly a lot of confusion out there, in addition to a plethora of different practice models.

    For me the reference of choice for stability, storage and compatibility was always the Handbook on Injectable Drugs, now in its 16th Edition. This reference was affectionately known as “Trissel’s” because the author of the book Lawrence A. Trissel is a legend in the field of injectable drugs. After Trissel’s I’d do a literature search to see if I could find something that wasn’t in there; typically I couldn’t. And finally, if I couldn’t find it in Trissels’s or the literature, I’d look at the manufacturer’s information.
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  • ASHP Summer Meeting 2012 full of pharmacy informatics stuff

    I attended the ASHP Summer Meeting last year in Denver, CO for the first time ever. The Summer Meeting was much smaller than the infamous Midyear Meeting, but I must say that there were some great informatics sessions. You can read about my experience last year here:

    Well, it looks like the 2012 Summer Meeting is primed and ready to offer just as much interesting informatics stuff this year. The meeting takes place in Baltimore, Maryland June 9-13, 2012. Hope to see you there.
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  • A couple of really nice webinars from Pharmacy OneSource coming up

    I received an email today from Pharmacy OneSource outlining their upcoming webinars. Pharmacy OneSource has been offering great webinars for a while now, but these really piqued my interest.
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  • Effect of med reconciliation on med cost after hospital D/C [article]

    The Annals of Pharmacotherapy March 20121

    BACKGROUND: Medication reconciliation aims to correct discrepancies in medication use between health care settings and to check the quality of pharmacotherapy to improve effectiveness and safety. In addition, medication reconciliation might also reduce costs.

    OBJECTIVE: To evaluate the effect of medication reconciliation on medication costs after hospital discharge in relation to hospital pharmacy labor costs.

    METHODS: A prospective observational study was performed. Patients discharged from the pulmonology department were included. A pharmacy team assessed medication errors prevented by medication reconciliation. Interventions were classified into 3 categories: correcting hospital formulary-induced medication changes (eg, reinstating less costly generic drugs used before admission), optimizing pharmacotherapy (eg, discontinuing unnecessary laxative), and eliminating discrepancies (eg, restarting omitted preadmission medication). Because eliminating discrepancies does not represent real costs to society (before hospitalization, the patient was also using the medication), these medication costs were not included in the cost calculation. Medication costs at 1 month and 6 months after hospital discharge and the associated labor costs were assessed using descriptive statistics and scenario analyses. For the 6-month extrapolation, only medication intended for chronic use was included.

    RESULTS: Two hundred sixty-two patients were included. Correcting hospital formulary changes saved €1.63/patient (exchange rate: EUR 1 = USD 1.3443) in medication costs at 1 month after discharge and €9.79 at 6 months. Optimizing pharmacotherapy saved €20.13/patient in medication costs at 1 month and €86.86 at 6 months. The associated labor costs for performing medication reconciliation were €41.04/patient. Medication cost savings from correcting hospital formulary-induced changes and optimizing of pharmacotherapy (€96.65/patient) outweighed the labor costs at 6 months extrapolation by €55.62/patient (sensitivity analysis €37.25-71.10).

    CONCLUSIONS: Preventing medication errors through medication reconciliation results in higher benefits than the costs related to the net time investment.

    Based on the exchange rate mentioned in the study (EUR 1 = USD 1.3443) the six month savings associated with medication reconciliation was about $75 U.S. per patient after factoring in labor. Not exactly earth shattering, but nothing to turn your back on either. At least there’s a positive ROI.

    I would have liked to have seen the authors take the study one step further by linking the medication reconciliation savings back to hospitalization readmission and/or effect on the patient’s lifestyle/activity. Once in a while optimizing a patient’s therapy might mean trading a more expensive drug for ease of use or improved patient compliance.

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    1. Karapinar-Çarkit F, Borgsteede SD, Zoer J, Egberts TC, van den Bemt PM, van Tulder M.Effect of medication reconciliation on medication costs after hospital discharge in relation to hospital pharmacy labor costs. Ann Pharmacother. 2012 Mar;46(3):329-38. Epub 2012 Mar 6. PubMed PMID: 22395255.

  • 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.
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  • “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).

  • We’re asking the wrong questions

    thoughtful_monkeyA couple of weeks ago I spent the morning with a friend of mine. He also happens to be a pharmacist and the director of a pharmacy IT group for a medium-sized healthcare system. As one might imagine we have similar interests, which means we spend most of our time together talking about pharmacy; where we’ve been, where we’re going, how to make it better, and so on. We both think that pharmacy is moving at a glacial pace when it comes to making important changes and any real change will likely occur long after we’re both retired.

    One thing that occurred to us during the conversation was that we always seem to ask the same questions, which always results in the same answers.

    • How do make a process faster [to free up pharmacist’s time]?
    • How do we make a process more efficient [to free up pharmacist’s time]?
    • How do we make a process better [to free up pharmacist’s time]?
    • Etcetera

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  • Great response to “Why pharmacy continues to fail”

    The Cynical Pharmacist (TCP) dropped by my site and left a great comment in response to my  Why pharmacy continues to fail. I don’t know who TCP is, but I hope to meet him in person some day. I get the impression that we would have some great dinner conversation; some pharmacy related, some not.

    You can see more of his musings on Twitter – @TheCynicalRPH

    TCP makes some great points in his comment, and in my opinion his thoughts reflects the sentiment of many pharmacists practicing in the real world. I was going to refer you to the comment, but felt it would be better to post the meat of it below:

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  • Why pharmacy continues to fail

    I’ve been a pharmacist since 1997. The profession of pharmacy, and therefore the basic principals of the practice, haven’t changed in that time. During my career I’ve worked in six different hospitals (1 in operations, 2 as a clinician, 2 general practice, 1 informatics), one long-term care pharmacy, once as a consultant pharmacist in long term care, in retail for two different retail chains, one community pharmacy and as a relief pharmacist for about a year. Looks pretty bad when I put it in writing. What can I say, I get bored.
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