Health System

When three infants died in September after receiving an adult dose of heparin at an Indianapolis hospital, patient safety experts pointed to the absence of bedside bar-coding-a technology they claim could have prevented the tragedy.

Disposing of hazardous pharmaceutical waste is nothing new for hospitals. However, the task has become more challenging in recent years due in part to a greater variety of toxic drugs that are being discarded.

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.

As propofol utilization increases, so do the safety risks of fast-acting anesthesia. Readily adaptable oversight procedures for propofol management by clinical pharmacists have led to the awarding of medication safety awards to two hospitals by the Delaware Valley Healthcare Council in Philadelphia (DVHC).

Recognizing that health systems are failing to success-fully manage inpatient diabetes, the Joint Commission on Accreditation of Healthcare Organizations and the American Diabetes Association (ADA) joined forces recently to implement the inpatient diabetes certification of distinction program.

The American Association for Respiratory Care (AARC) recently launched a free Web-based tutorial to educate those with asthma and chronic obstructive pulmonary disease (COPD) about the proper use of their inhaled medications.

Ortho-McNeil Neurologics (OMN) has launched a campaign to warn pharmacists about prescribing and dispensing errors. The campaign centers around two OMN drugs, topiramate (Topamax) and galantamine (Razadyne and Razadyne ER).

A 59-year-old Caucasian woman, D.P., is seen regularly in your hospital's diabetes clinic. Daily medications include glipizide ER (Glucotrol XL, Pfizer) 10 mg, pioglitazone (Actos, Takeda) 45 mg, metformin ER (Glucophage XR, Bristol-Myers Squibb) 500 mg, citalopram 40 mg, ezetimibe/simvastatin (Vytorin 10/80, Merck/Schering-Plough), aspirin 81 mg, lisinopril 40 mg. Glycemic control appears good (A1c=7.0), but she has gained >40 lb. in four years (BMI=33). Despite a Jenny Craig diet (1,200 calorie/day) for six months, plus three weekly sessions with a personal trainer, she has lost only 2 lb. D.P. saw a blog claiming pioglitazone causes weight gain-she believes that is her problem. Her physician asks your opinion. What do you say?

Recent news reports linking methadone with a number of casualties, including that of the actress Anna Nicole Smith's son, have fostered the idea that the substance is a "killer" or dangerous drug of abuse. This is a bit paradoxical since methadone has been successfully used in heroin detoxification programs for decades.

Pharmacists who see a move toward outpatient parenteral therapy are riding the latest shift in patient care. A new report from the Emerging Infections Network (EIN) found that OPAT, outpatient parenteral antimicrobial therapy, has become the de facto standard of care in most hospitals. EIN is part of the Infectious Diseases Society of America.

The 2007 pipeline promises novel therapeutic classes for some diseases but no new drugs in others

The focus of medicine lies not only in searching for viable treatments and cures for existing ailments but also in the prevention of disease. Vaccination induces immunity after an antigen is introduced to the body. This antigen usually consists of a live attenuated organism, an inactivated organism, a toxoid, or parts of an organism (acellular and subunit). The antigen is incapable of resulting in the full-blown manifestation of the disease, but it is potent enough to generate the formation of antibodies to protect against future illness. Traditionally, vaccination has been used to combat the spread of infectious diseases, such as cholera, rabies, polio, measles, and hepatitis. And this is still the case.

A new software version for managing orders and calculations for total parenteral nutrition (TPN) compounding was released by Baxa Corp. in August. The company supplies about 70% of the nation's hospitals with automated TPN compounding products.

Protocolized Care for Early Septic Shock (ProCESS), a new multicenter research consortium, is beginning a large-scale study to determine whether specific interventions can halt the progression to severe sepsis or septic shock. Every year, about 750,000 people in the United States are affected with severe sepsis and about 200,000 people die from it. Sepsis is a syndrome characterized by a systemic response to infection that can rapidly lead to death. It is the leading cause of death in noncoronary intensive care units.

Over the years, long-term use of immunosuppressive medications has shown that they reduce morbidity and mortality in transplant patients. One of physicians' challenges is to balance the risk of organ rejection caused by underimmunosuppression with the risk of drug toxicity, secondary infections, and posttransplant lymphoproliferative disorders caused by overimmunosuppressing the patient.

Several dozen neuropsychiatrists and others, at a recent meeting in Washington, D.C., emphasized the need for a national postmarketing surveillance system for drugs. But how will the country move to such a system?

NeoFax recently released an updated version of software for the preparation of total parenteral nutrition solutions for neonatal infants. Named WebApp, the software's data are based on what company officials say is the most widely used neonatal drug manual in the world- NeoFax: A Manual of Drugs Used in Neonatal Care-first published nearly 20 years ago.

A new software version for managing orders and calculations for total parenteral nutrition (TPN) compounding was released by Baxa Corp. in August. The company supplies about 70% of the nation's hospitals with automated TPN compounding products.

New legislation in California takes hospital reporting of serious medication errors to a new and very public level. Signed by the governor in late September, the law requires all hospital medical errors posing serious harm, including medication errors, to be posted on the state Department of Health Services' Web site. The Web site must include a description of the error, any corrective steps taken by the hospital or the state, and the name of the facility.

Suppose you were able to evaluate a hospital based on how well it has implemented quality and safety initiatives. The Leapfrog Group set out to do just that when it commissioned a survey to establish a national rating system that offers a broad assessment of a hospital's quality and safety. Fifty-nine hospitals have been named to Leapfrog's top hospitals list based on data from its survey.

Fungal infections are on the increase, but not for all the usual reasons. Increasing rates of bacterial and viral infections are due in large part to growing resistance to antimicrobials, but fungi and antifungals are different.

The International Society for Heart & Lung Transplantation (ISHLT) has released the first international guidelines for managing heart failure (HF) patients prior to heart transplantation. HF is a serious condition in which the heart is unable to pump blood at a rate sufficient to meet the needs of the body. "The new guidelines will enhance the effectiveness of patient care, optimize patient outcomes, and improve overall cost by focusing resources on the most effective strategies," said Mariell Jessup, M.D., ISHLT task force chair and professor of medicine at the University of Pennsylvania Medical Center.

A 20-year-old patient, T.C., managed in your hospital's asthma clinic has recently been diagnosed with paroxysmal supraventricular tachycardia (SVT). To control his asthma, T.C. uses a fluticasone 250 mcg/salmeterol 50 mcg inhaler (Advair Diskus, GlaxoSmithKline) regularly plus an albuterol inhaler as needed. T.C.'s physician suspects the beta agonists used to control asthma could be a factor in T.C.'s episodes of SVT. He requests a pharmacist consult about how best to deal with the asthma to prevent episodes of heart arrhythmia. What do you suggest?

Diabetes is undertreated among inpatients, especially acute care patients, sometimes with devastating results. "Blood glucose levels are too often not treated as intensively as other medical conditions among floor patients," said Almut G. Winterstein, Ph.D., assistant professor of pharmacy health care administration at the University of Florida College of Pharmacy. "If hospitals made a more aggressive effort, it could save quite a significant number of lives."

Dasatinib (Sprycel, Bristol-Myers Squibb) is a new tyrosine kinase inhibitor for chronic myelogenous leukemia (CML). The Food & Drug Administration approved the drug in June, and now the National Comprehensive Cancer Network (NCCN) has added dasatinib to its CML guidelines.

Drug-eluting stents (DESs) greatly reduce the chances of restenosis, a gradual growth of abnormal cells within the stent. However, the results of a new study reveal that DESs may also put patients at a higher risk for a sudden and potentially fatal thrombosis.

The Food & Drug Administration recently approved fentanyl buccal tablets (Fentora, Cephalon) for the management of breakthrough pain in cancer patients who are already receiving and who are tolerant to opioids for their underlying persistent cancer pain. Fentora is the first and only buccal tablet approved for this indication and is the first tablet formulation of the opioid fentanyl. It is also the first new medication approved for the treatment of breakthrough pain in opioid-tolerant patients with cancer since 1998.

At most large tertiary care hospitals and academic medical centers, around-the-clock pharmacy service is relatively common. But in some small and rural hospitals, 24-hour, seven-day-a-week pharmacy coverage is not economically feasible or practical. How are pharmacy services provided in those facilities? And how do health-system pharmacists feel about a Joint Commission on Accreditation of Healthcare Organizations proposal that would require all hospital pharmacies to provide 24/7 service?

Recent years have seen dramatic growth in the specialty pharmacy market, a segment of the industry addressing the needs of patients with chronic illnesses such as cancer and HIV. Sales of specialty medications-though expensive, often injectable, and typically requiring more patient education-have trended upward at more than 25% annually for the past five years. Industry experts forecast annual increases of more than 30% through the rest of this decade, according to Armada Health Care, a specialty pharmacy group purchasing organization in Short Hills, N.J.