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For many years, doses and rates of administration for continuousinfusions in pediatric patients have been based upon the "rule ofsix." This weight-based method relies on the following formula: sixtimes body weight is the amount of drug to be added to 100 ml ofcarrier fluid.

Cerner Corp.'s CareAware RxStation characterizes the nextgeneration of automated medication dispensing systems. Itintegrates electronic medical records with dispensing cabinets. "Itis a closed-loop system," said Dawn Iddings, director of resourceplanning for the company's device innovation group. "It's anend-to-end solution, fully integrating ordering, dispensing, andadministration at bedside, through a completely sealed device."

Medication errors involving neuromuscular blocking agents (NMBAs)are potentially serious and life-threatening because these agentsparalyze respiratory muscle and, if misused, can adversely affectrespiratory function. NMBAs should be administered only by staffwith experience in maintaining an adequate airway and respiratorysupport in facilities where intubation can readily be performed,oxygen can be administered, and respiratory support can beprovided.

Despite a new Food & Drug Administration mandate, which wentinto effect April 26 requiring all drugs supplied to hospitals tobe bar-coded, less than 10% of U.S. hospitals have a bedsidebar-coding system in place. Many hospital pharmacy executives saythe main reason they are not on board yet is the high cost ofimplementing it.

The pharmaceutical supply chain works wonders, bringing thousandsof drug products to hospitals just as local inventory is fallingtoward zero. The problem is that every chain, including supplychains, is prone to kinks.

Regarding the Clinical Twister in your Feb. 20 issue, the clinicalrecommendations for treating Clostridium difficile infections arecorrect but incomplete. Addition of probiotics is commonlyoverlooked, yet probably the most important therapeutic agent inrepopulating the gut with healthy flora. Probiotics are inexpensive(cost-effective) and very safe. A normalized flora stabilizes thegut, reduces diarrhea, and may help in reducing risk of C.difficile by competitive displacement.

A 68-year-old man is hospitalized with shortness of breath,fatigue, and 2+ edema-his third hospitalization in 12 months.He has heart failure (HF) (currently New York Heart Associationclass IV, ejection fraction 20%), LVH, and MI history. Heart rhythmis normal; lungs clear; lab tests within normal limits excepthemoglobin510.5 gm/dl, SrCr52.3 mg/dl; BP5160/90, pulse 85,respiratory rate522. Admitting medications: furosemide 80 mg,potassium (K), benazepril 20 mg, aspirin 81 mg, carvedilol (Coreg,GlaxoSmithKline) 6.25 mg twice daily. The resident continues allmedications, increasing furosemide to 80 mg twice daily. He askswhether adding digoxin might reduce future hospitalizations.

The National Comprehensive Cancer Network (NCCN) recently sponsoreda roundtable discussion called Cancer Care in the 21stCentury-Reality and Promise. The panelists discussed a widerange of topics, including the most important advances in cancercare since the war on cancer was declared during the NixonAdministration in 1972 and how pharmacogenomics is revolutionizingcancer treatment. The roundtable meeting, at which the group ofoncology leaders assembled for the first time, took place duringthe NCCN 11th Annual Conference, held recently in Hollywood, Fla.

Medication therapy management (MTM) was the recurring theme at thisyear's Academy of Managed Care Pharmacy (AMCP) meeting, heldrecently in Seattle. The American Pharmacists Association led aworking group of 11 pharmacy organizations to define MTM servicesin 2004. This year, a similar working group led by AMCP defined MTMprograms. The resulting consensus document was presented at theAMCP meeting.

Increased customer satisfaction and Rx drug sales ... New pharmacy and supermarket customers ... Another way to differentiate yourself from the competition. These are some of the potential benefits of opening an in-store clinic. You may want to be the first on the block to provide that point of difference. If you don't do it, you may be at a competitive loss.

For the seventh consecutive year, pharmacists requested a recordnumber of licensure transfers last year, according to the NationalAssociation of Boards of Pharmacy.

When I think of the best job I ever had, I have vivid, pleasantmemories. There was pharmacist overlap-and that is the singlemost important criterion for a job to even get in the running forbest job. One of us came in at 9:00 a.m., and the other started hisshift at noon. We worked together for four hours. There was aconstant back-and-forth banter in the pharmacy. The techs jumpedinto the fun with both feet. We joked and laughed and kidded eachother. There were times when the topic of the day was not so funny.We stuck together when a tech needed to clear her head about animpending divorce. Once there was the stress of a child being hitby a car. For me, it was a second family.

Pharmacists who want to get involved at the grassroots level can contact the resources listed below.

The CDC now estimates that more than 70% of bacteria that causehospital-acquired infections are resistant to at least one of thedrugs most commonly used to treat them. With an antibiotic pipelinethat has been quite dry for some time, clinicians continue to worryabout how they'll treat patients who develop resistant infections.Given the unrelenting nature of bacteria to mutate in an effort tooutsmart even the most powerful antibiotics, creating newanti-infectives will always be required. Here are several drugs,currently under review by the FDA, that may soon offer us a fewmuch-needed options:

Daytrana should be applied once-daily and removed after a period ofnine hours from time of application.

The new Pharmacy Quality Alliance (PQA), pushed by the Centers forMedicare & Medicaid Services to develop measures of pharmacyquality, should be working toward some early proposals by late May,according its originators.

CMS has ruled that when Medicare Part D plans impose newrestrictions or eliminate a drug from their formularies, they mustcontinue coverage for the remainder of the year on anybeneficiaries who were already taking the medication.

With the government more an adversary than an ally these days andalso the biggest payer of drugs in the country, NACDS chairman TonyCivello vowed that the association would "get confrontational" ifnecessary to push its agenda. Calling 2005 a year with fewpositives, Civello acknowledged that the association is in part toblame for the bind community pharmacy is in now. Also at fault:pharmacy's fragmented voice, which makes it a weak link vis-?-visdrugmakers and PBMs. To remedy this situation, he said, NACDS andNCPA have formed a coalition to present a unified front forcommunity pharmacy. He made these remarks at the association'sannual meeting in West Palm Beach, Fla., this month.

Due to high demand for a replay, CMS has made available a recordingto its recent pharmacy open door forum on the Pharmacy QualityAlliance. The on-line audio of the telephone conference call can beaccessed at www.cms.gov/pharmacy.

Rhode Island has received the first-ever SafeRx Award for promotionand adoption of electronic prescribing. Nevada, Massachusetts,Maryland, Florida, Delaware, Virginia, North Carolina, Ohio, andMichigan rounded out the top 10 e-prescribing states.

USP has announced a public comment and review period process forproposed changes to USP General Chapter 797 PharmaceuticalCompounding of Sterile Preparations. The public comment period willend on Aug 15. In addition, USP will host a series of six Webinarsdesigned to provide additional information on the proposedrevisions.

CMS has announced a proposed rule change to launch a competitivebidding program for durable medical equipment (DME) in 2007. CMScurrently pays for DME based on a listed price. Under the proposedchange, DME companies would submit bids to CMS.

Five trends will improve drug compliance in the next five to 10years. They include e-prescriptions, electronic healthcare records,standard messaging, RFID, and pay for performance.

CDC has confirmed that an aggressive fungal eye infectionassociated with contact lens use has now been found in 31 statesand may be affecting more than 200 people. U.S. health officialssaid 32 of 58 people with fungal infections used Bausch &Lomb's ReNu with MoistureLoc, which Bausch & Lomb voluntarilypulled from the market on April 10.

The Consumer Healthcare Products Association (CHPA) announced itssupport of the introduction of the Dextromethorphan DistributionAct of 2006 (H.R. 5280).

The NACDS Foundation has donated $216,500 in scholarships to beshared by all 92 pharmacy schools. The awards ranged from $1,000 to$20,000. In a random drawing for the largest awards, $20,000 wentto Wayne State University, while Idaho State University and PalmBeach Atlantic University each received $10,000.

CMS has mandated that Part D drug plans allow 180 days for filingclaims incurred between Jan. 1 and June 30. Problems withcoordination of benefits have required the reversal of claims andrebilling to the appropriate payer. Since a lack of information ledpharmacies to sometimes bill the wrong payer, they should not beheld to the usual 30- to 90-day timely billing standard, CMSconcluded.

Cardinal Health's RFID pilot will attach tracking tags to thelabels of drugs at a facility in New Jersey. The drugs will then beshipped to a Philadelphia facility, which will encode an electronicproduct code standard data at the unit, case, and pallet levelduring the packaging process.

Due to high demand for a replay, CMS has made available a recordingto its recent pharmacy open door forum on the Pharmacy QualityAlliance. The on-line audio of the telephone conference call can beaccessed at www.cms.gov/pharmacy.

TestPak, a N.J.-based healthcare contract packager, announced itplans to acquire and install the first production equipment tosupport its launch of Stora Enso's Pharma SHR child-resistant andsenior-friendly packaging system. The installation is slated forthis month.