JFahrni's blog

It feels like a day doesn’t go by that I don’t receive an email letting me know of something cool for mobile devices. With the ever increasing onslaught of tablet and smartphone use in pharmacy practice it’s only a matter of time before everything will be available in some electronic media format.

In this case it’s ASHP’s Interactive Handbook on Injectable Drugs: IV Decision Support by Lawrence A. Trissel. Every pharmacist working in a hospital pharmacy knows about this reference. And if they don’t then they have a big problem because it’s only one of the most definitive reference sources for IV compatibility. Over the course of my career it’s simply been know as “the Trissel’s”. (kind of like “the Talyst”…just sayin’ – private joke people)

There’s a link in the ASHP web store leading to a “getting started video”, but I couldn’t get the video to run. Little bit of a fail. Perhaps ASHP’s never heard of YouTube. Who knows.

I received the email below a few days ago announcing that The Tarascon Pharmacopoeia is now available for Android and the iPad. I’m not a big fan myself, but the reference appears to be popular with certain crowds. Historically it’s more popular with community/retail pharmacists than hospital pharmacists. This might have something to do with the availability of drug pricing in the Tarascon Pharmacopoeia. Who knows.

Link to Android version is here.

Link to iPad version in iTues store is here.

I’ve just spent four days at the ASHP Summer Meeting in Denver, CO. The meeting offered a nice variety of topics, but seemed to focus on medication safety and informatics more this year than in the past. In fact, this is the first year that ASHP has offered a medication safety tract at one of their meetings.

I avoided the more traditional sessions on therapeutics, choosing instead to focus on the informatics and medication safety sessions. Based on the information presented it was obvious to me that these two disciplines are intimately linked. After all, the idea behind much of the technology we use in healthcare today is to improve patient safety.

In 1999, the Institute of Medicine (IOM) published the now infamous To Err Is Human: Building a Safer Health System. The information presented in that report sent shockwaves through the healthcare industry. More than a decade later we haven’t seen much improvement in the number of mistakes made in hospitals, but To Err Is Human effectively changed the foundation of healthcare forever. While healthcare remains squarely focused on caring for patients, the approach to how we provide that care has changed dramatically. The interest on patient safety has generated an immense body of literature aimed at using automation and technology to improve patient care.

Ours is an age of information. It comes at us from all directions; unrelenting and ever present. Finding information is no longer a problem, figuring out what to do with it and how to handle the never ending stream of information is.

Cyberspace, i.e. the internet is full of information. It’s available via weblogs, online journals, social media, through professional organizations, via webinars and so on. The problem is that the information has no meaningful structure, making it difficult to sift through. What’s worse is trying to figure out what information is reliable and what information isn’t.

Technology websites like Endgaget, for example, are full of information about today’s latest technology ranging from smartphones and tablets to miniature cameras used for gastrointestinal studies. The advantage of such a sight is obvious; it provides one with information on the most up to date cutting edge technology. The downside, however is that the information comes at such a pace that it can be overwhelming. Websites like ASHP.org are a great place to grab information about pharmacy. Although the information is often static, ASHP offers reliable information on the current status of pharmacy practice.

“A life spent making mistakes is not only more honorable, but more useful than a life spent doing nothing.” - George Bernard Shaw

Everyone makes mistakes, but not everyone understands their value or takes advantage of the information they provide. Mistakes are painful, frustrating, expensive and at times dangerous, but the reality is that they are valuable in the evolution of everything from creating a better smartphone to developing lifesaving technologies. I believe you learn as much from your mistakes as you do from your successes. Avoiding mistakes means one of two things. Either you’re not trying hard enough or you’ve learned enough from previous mistakes to avoid repeating them. The latter is good, the former bad. According to Don Dodge of Google “achieving 65% of the impossible is better than 100% of the ordinary”. I’ll buy that.

A wise colleague of mine once told me that lots of people collect data, but few people know what to do with it. I didn’t understand what he was talking about at the time, but I’ve come to have a better understanding over the years. It basically boils down to the difficulty that many of us experience when it comes to the best way to handle information. Our brains do some amazing things, but fail to “see” things when the perspective is all wrong.

Data surrounds us. It’s in everything we do, from the bank statements we receive in our personal life to the mountains of data collected by every healthcare institution. Regardless of the data collected, there are basically three things that can be done with it. Data can be ignored, it can be archived or it can be used. Unfortunately only one of those three things is truly useful; using it. Many people chose to ignore or archive data not because the information isn’t valuable, but because they are overwhelmed with the amount of information they receive and the way that the information is presented.

Presentation is everything when it comes to data. The methods we chose to present information can make the difference between the information being useful or being useless. The significance of such a problem creates a quagmire for pharmacists as theirs is a data driven environment. Pharmacists spend a great amount of time emerged in data; patient data, lab data, micro data, kinetics data, drug data, usage data, nursing data, physician data, and so on.

Data visualization and dashboards can help. They provide us with the tools to better understand the information around us, and therefore improve efficiency in the process.

I’ve worked in several hospitals over the course of my career, ranging in size from 25 acute care beds to nearly 600 (584 beds to be exact). While 600 beds isn’t a large hospital, it certainly isn’t small. Regardless of the size of the hospital I’ve worked in, the operations inside the walls of the pharmacy are strikingly similar, including from the way pharmacists process orders to the way technicians handle distribution. There are differences to be sure, but the basics are the same. Differences to note include clinical services and use of automation and technology.

Smaller facilities typically have fewer pharmacists resulting in a more centralized approach to pharmacy services, while larger facilities typically have more pharmacists to shuffle around into a broad range of pharmacy services. Larger facilities typically have a more developed, more robust clinical services often including clinical specialists in fields such as cardiology, infectious disease, critical care medicine, pediatrics, and so on. Unfortunately, smaller facilities typically don’t have the luxury of a clinical specialist because they don’t have pharmacists to spare.

Beyond clinical services, I find smaller facilities tend to lack the amount of automation and technology that I see in larger facilities. It’s not for lack of desire, but rather a lack of funds. Budgets appear to be proportional to hospital size (i.e. the larger the hospital, the bigger the budget), which results in smaller facilities utilizing less technology and automation. This doesn’t mean that small hospitals aren’t progressive in their approach; it simply means that you won’t find many million dollar robots filling carts for 20 patients.

WSJ: “The Food and Drug Administration said Tuesday that it will require some painkiller manufacturers to produce new educational tools in an effort to quell prescription-drug abuse.

The requirements will affect makers of long-acting and extended-release opioids, which include oxycodone, morphine and methadone.

Letters have been sent to manufacturers of the drugs describing the medication guides and tools for physician training that are now required, FDA Commissioner Margaret Hamburg said. The FDA will approve the materials, which will also be accredited by professional physician-education providers, she said, a step meant to combat bias in the materials.”

Oh. My. Gosh. Let me see if I can wrap my brain around this. The FDA is going to require that manufacturers of certain “painkillers” tell physicians how to properly use the drugs instead of requiring physicians to read the literature and do exactly what they’re trained and paid to do. Crud, it’s nothing a good pharmacist couldn’t fix. Why doesn’t the FDA simply require physicians to run these same prescriptions through a pharmacist for approval or give pharmacist prescriptive authority instead. It makes a lot more sense than putting the manufacturers in charge of the asylum. I would be utterly embarrassed if a drug manufacturer had to tell me how to properly use a drug because I couldn’t get it right. I think the healthcare system has officially reached a new low. Unfortunately this ain’t no limbo contest.