Health System

A frail 75-year-old man, T.W., has been admitted to your hospital. He has a fever of 102°F, along with bloody diarrhea and abdominal pain. Prior to his admission, T.W.'s medications included the following: valsartan (Diovan, Novartis ) 80 mg daily, metoprolol 25 mg daily, aspirin 81 mg daily, simvastatin 40 mg daily, warfarin 3 mg on Monday, Wednesday, Friday and 2 mg on Tuesday, Thursday, Saturday, and Sunday. (T.W. suffered a myocardial infarction six months ago.) His last INR was 4.0. Because he had been hospitalized 14 days prior for S. pneumoniae pneumonia that was treated with ceftriaxone, the admitting physician suspected a C. difficile infection, which was subsequently confirmed by the lab. The physician has now ordered metronidazole 500 mg three times daily for T.W., and your computer flags that as a significant drug interaction. What do you recommend to the physician?

Pharmacist salaries are still climbing, but at a slower rate. Our exclusive survey shows who gets top dollar.

The Alaska Native Medical Center (ANMC) is the recipient of the 2006 Award for Excellence in Medication-Use Safety. McLeod Regional Medical Center and St. Joseph's/Candler Health System were honored as award finalists. The three sites were chosen by a multidisciplinary team based on four criteria: medication use system initiative/scope, planning and implementation, measurable outcomes and impact, and innovation and applicability.

Early reaction to changes in the 340B drug program proposed by the Health Resources and Services Administration (HRSA) is mixed. Proposals to expand patient access through greater use of contract pharmacies get a generally favorable response. Proposed changes that would tighten definitions of eligible patients have raised questions.

Healthcare experts from two Michigan hospitals are helping the Food & Drug Administration find ways to prevent medical device errors. The FDA hired Beaumont Technology Usability Center (BTUC) late last year to help identify the causes of and risks associated with tubing and catheter misconnection errors. The move is part of an ongoing national effort by the FDA to closely monitor the safety of medical devices.

The results of a new study indicate that lower literacy and a greater number of prescription medications can lead to the misinterpretation of the instructions on prescription drug labels. The study, "Literacy and misunderstanding prescription drug labels," was released on-line in November and published in the Dec. 19 issue of Annals of Internal Medicine.

Switching community-acquired pneumonia patients as quickly as possible from intravenous to oral antibiotics reduces hospital stays and improves the quality of care, according to many studies. One recent study suggests that even patients with severe CAP may be safely moved to oral antibiotics early in their stay. Health-system pharmacists should be aggressive in promoting that switch, say several clinical pharmacists.

A 75-year-old man, D.P., is seen regularly in your hospital clinic for severe chronic obstructive pulmonary disease (COPD) as a result of a 50-year pack-a-day habit (FEV<50% predicted). He quit smoking last year but still admits to being a heavy drinker. His current medications include fluticasone/ salmeterol 250/50 mcg (Advair, GlaxoSmithKline) one puff twice daily and albuterol inhaler when needed. He has had several COPD exacerbations within the past year, necessitating oral steroid therapy. He was just diagnosed with osteoporosis: recent X-rays show two vertebral fractures. His physician is contemplating osteoporosis therapy. What do you recommend?

The National Comprehensive Cancer Network (NCCN) recently updated its guidelines for the prevention of emesis in patients receiving chemotherapy or radiation. The new guidelines serve as an update to the 2006 guidelines and are consensus based, with explicit review of the scientific evidence by a multidisciplinary panel of expert physicians and pharmacists.

Practitioners will now have access to consensus standards for the treatment of venous thromboembolism (VTE). The National Quality Forum (NQF) has announced publication of a new report, National Voluntary Consensus Standards for Prevention and Care of Venous Thromboembolism: Policy, Preferred Practices, and Initial Performance Measures.

There was a time when the diagnosis of cancer was ominous, but not anymore. Cancer has evolved into a chronic disease, with 95% of cancer patients treated in outpatient settings. Novel drug therapies and advances in radiation treatment have made many cancers survivable. That's good news for patients, and so is the fact that pharmacists are playing a more pivotal role in managing not only the clinical but also financial aspects of patient care.

CHD Meridian Healthcare, an I-trax Inc. company, appears to have struck the right note with large corporations seeking to bring on-site clinics to their employees.

Picture this. A man walks into a pharmacy to buy condoms. He hopes he can quickly whisk them from the shelf and pay for them without attracting attention. But ... they are locked up in a case along with the razor blade cartridge replacements. A note on the cabinet states, "Please ask attendant for assistance for items in this case."

It is that time of the year when consumers flock to their local drugstores seeking the "long-trusted" remedies for the common cold and its associated symptoms-particularly cough. In response, pharmacists will be called upon to make therapy recommendations that suit the needs of each individual patient.

Like it or not, health-system pharmacies are under tremendous pressure to perform at a high level. Addressing patient safety concerns, improving outcomes, implementing state-of-the-art technology, and keeping drug costs down requires a juggling act that pharmacists must perform on a daily basis.

NIOSH, the National Institute for Occupational Safety and Health, is updating its list of hazardous pharmaceutical products. The new list will become part of the organization's 2004 alert, Preventing Occupational Exposure to Antineoplastic and Other Hazardous Drugs in Health Care Settings.

When Michelle Rutledge, Pharm.D., heard about the fatal shooting of a hospital pharmacist at Shands Jacksonville hospital in Florida last November, it really hit home. The victim, 37-year-old Shannon McCants, was a fellow graduate of the Florida A&M College of Pharmacy. McCants was shot by a customer who was waiting for a prescription to be filled in the outpatient pharmacy. Rutledge, an associate investigator at the James A. Haley VA Hospital in Tampa, said that e-mails from former student-colleagues began pouring in.

Treating heart attacks and agents affecting risk factors for heart disease were among the hot topics explored at the American Heart Association's 2006 annual meeting held recently in Chicago. Also, a program on increasing adherence to pharmacotherapy among the elderly was of interest to attendees.

Pharmacists at one of the nation's largest military medical centers found that elderly patients are likelier to comply with drug regimens following a program of patient education, pharmacy counseling, and specially packaged drug blisterpacks. Jeannie Lee, Pharm.D., and Karen Grace, Pharm.D., clinical pharmacists at the Walter Reed Army Medical Center, led the research. "The Federal Study of Adherence to Medications in the Elderly" (FAME) was published in the Dec. 6 issue of the Journal of the American Medical Association.

At the ASHP Midyear Clinical Meeting in December, technology vendors from the largest system integrators to mom-and-pop software startups hawked their products and services. Bedside bar-coding, medication management tools, and smart pumps were among the dominant product categories displayed.

Last month, the House Ways and Means Committee held a hearing on patient safety and quality issues regarding end-stage renal disease (ESRD) treatment. In his opening remarks, outgoing committee chairman Rep. Bill Thomas (R, Calif.) acknowledged that Medicare payments for the treatment of ESRD increased by almost 50% between 1998 and 2003. In fact, epoetin alfa (Epogen, Amgen) has been identified as the single largest drug expenditure in Medicare Part B each year.

A 24-year-old woman, R.S., who is two months' pregnant, presents to your ER with a severe migraine that has lasted >48 hours. She reports having several migraines a week since she became pregnant, but until now has successfully "slept them off" in a quiet, dark room. Prior to her pregnancy, R.S. had used zolmitriptan nasal spray (Zomig, AstraZeneca) to abort migraines. She was also using amitriptyline 100 mg daily for prophylaxis. The neurologist on call is debating how to treat R.S. He requests a pharmacist consult. What do you recommend and why?

Treating heart attacks and agents affecting risk factors for heart disease were among the hot topics explored at the American Heart Association's 2006 annual meeting held recently in Chicago. Also, a program on increasing adherence to pharmacotherapy among the elderly was of interest to attendees.

Sometimes in medication safety the simplest solution is the best.

Final rules on hospital participation in Medicare and Medicaid may help pharmacists crack down on patients who try to provide their own drugs for hospital use. The practice is called "brown bagging," from the brown paper bags patients get from retail pharmacies.

With traumatic brain injury (TBI), the first question we often ask is, Will the patient recover? Beyond concerns about cognitive function and disability, little is generally known about the milestones and setbacks patients encounter while recovering from a TBI.

A recent study by researchers at the Mayo Clinic College of Medicine has raised questions about the safety of administering nicotine replacement therapy (NRT) to smokers in the intensive care unit (ICU). Until now, use of NRT was not thought to be associated with serious adverse events. In fact, the Agency for Healthcare Research & Quality (AHRQ) recommends smoking cessation treatment for hospitalized patients.

With an estimated 90,000 deaths annually linked to hospital-acquired infections, preventing the spread of drug-resistant infections is a top priority for health-system pharmacists. A new guidance document from the Centers for Disease Control & Prevention, "Management of Multi-Resistant Organisms in Healthcare Settings," is getting good marks for providing tips on how to stem these infections.

According to the U.S. Census Bureau, every 31 seconds a limited-English speaker enters the United States. For the approximately 48 million residents who speak a language other than English at home, that language barrier looms large when they visit an emergency room or are admitted to a hospital.