Health System

ASHP's revised guidelines on the handling of hazardous pharmaceuticals could not have come at a more opportune time. As chemotherapy agents become more powerful and chemotherapy administration shifts from the inpatient setting to physician offices and infusion centers, controlling occupational exposure to hazardous drugs has taken on a new urgency.

As antimicrobial resistance continues to increase inexorably, the good news is that so far there are very few clinical situations for which there are no therapeutic options, said Robert Moellering Jr., M.D., researcher at Harvard Medical School. "But we are getting very, very close," he warned.

The exhibit floor at the ASHP summer meeting in Orlando was sizzling with the latest wares on display for hospital pharmacy in categories ranging from automation solutions to dispensing equipment, computer hardware and software, drug administration devices, packaging equipment, and pharmacy management services.

In August 2005, Woodland Heights Medical Center (Lufkin, Texas) pharmacy technician Fred Poage, CPhT, was taking a computer programming course while pursuing a mathematics degree at nearby Stephen F. Austin State University. Staff pharmacist Eddie Purifoy, R.Ph., challenged Poage to put the course to good use. "Why don't you do something really useful-tackle this Xigris problem?"

The Centers for Medicare & Medicaid Services has joined a growing list of payers that are giving hospital patients and other medical consumers detailed price and quality information. In June, CMS posted its negotiated rates for 30 common hospital procedures at www.cms.hhs.gov/healthcareconinit/01_overview.asp. Other hospital data are at www.HospitalCompare.hhs.gov.

The formula being used by Medicare to determine the reimbursement rates for intravenous immune globulin (IVIG) is creating serious problems for patients, physicians, hospitals, and pharmacists. The formulas used were changed for physicians' offices and homecare settings in 2005 and for hospital-based settings at the beginning of 2006. Reimbursement rates for almost all approved IVIG products are now below the costs of the products and this, combined with periodic supply shortages, has had patients and hospitals scrambling.

How much difference can pharmacists really make in the critical care unit? A group of R.Ph.s from two neighboring states set out to prove they could accomplish just about anything.

A recent Department of Health & Human Services report revealed that two-thirds of patients needing critical care services may be receiving suboptimal care. The reason? The current demand for critical care services has surpassed the supply of critical care specialists (intensivists) needed to provide optimal care. The report projects that this problem will be even more severe by 2020 due to the aging population and the increased utilization of intensivists.

Hospitals with large indigent patient populations have a new financial ally: the Medicare Part D outpatient pharmacy benefit.

Thanks in large part to vaccination of children and adolescents, the number of new cases of hepatitis B in the United States has declined over the past decade or so. However, the hepatitis B virus (HBV) is still a problem. The Centers for Disease Control & Prevention estimates that about 1.25 million people have been infected with HBV, and about 5,000 Americans die each year from complications of the disease.

A 55-year-old male, P.N., is being followed in your cardiovascular risk reduction clinic. He has been titrated up on Avalide (irbesartan/hydrochloro-thiazide, Bristol-Myers Squibb/Sanofi-Aventis) and today his blood pressure is 130/80. He also takes Vytorin 10/80 (ezetimibe/simvastatin, Merck/Schering- Plough) daily. His current lipid panel is HDL 42, LDL 79, TC 145, triglycerides 120, but he is complaining of severe muscle pain of recent onset. Four days ago, his physician prescribed Ketek (telithromycin, Sanofi-Aventis) 800 mg daily for acute sinusitis. His sinusitis is now asymptomatic. What do you recommend?

The American Society of Clinical Oncology (ASCO) recently issued updated evidence-based practice guidelines for the use of antiemetics in patients who are receiving chemotherapy or radiation. Chemotherapy-induced emesis can negatively affect a patient's quality of life and may have an impact on compliance with future treatments. Approximately 70% to 80% of all cancer patients receiving chemotherapy experience emesis.

I would like to make a clarification to your article appearing in your June 19 issue entitled "Hospitals save with Premier's generic-substitution program." In the last paragraph of the article, it discusses how Premier hospital members, including those that qualify as disproportionate share hospitals (DSHs), are eligible to participate in Premier's new autosubstitution program. This statement should be clarified as it relates to DSHs participating in the 340B Drug Pricing Program. Such a substitution program can be used only within the inpatient, acute care setting in such DSHs. The Health Research & Services Administration's Office of Pharmacy Affairs, which administers the 340B Drug Pricing Program, requires eligible hospitals to certify that they do not participate in a group purchasing organization (GPO) or any other relationship for the purchase of outpatient covered drugs.

Tenfold drug administration errors are common and pernicious in healthcare systems, but they could be almost entirely eliminated. They occur when a decimal placement is written incorrectly or misread. Decimal errors can result in a 10-fold, 100-fold, or even 1,000-fold overdose or underdose. But experts say providers rarely need to use decimals, and, when they are necessary, many steps can be taken to limit errors.

Just a few years ago switching to a generic drug without consulting a physician or discussing it with the patient was a rare thing for a pharmacist to do. But the times are a-changin'.

The integration of patient-controlled analgesia (PCA) technology with devices that continuously monitor oxygen saturation (SpO2) and end-tidal carbon dioxide (ETCO2) significantly improves patient safety, according to innovators of the integrated safety platform.

A 76-year-old woman, L.R., is seen in your hospital for a hot, painful, red, swollen leg injury. Deep vein thrombosis is ruled out by ultrasound. L.R. is diagnosed with superficial venous thrombosis and compression stockings are prescribed. L.R. maintains her varicose vein problem worsened significantly when she started nisoldipine (Sular, First Horizon Pharmaceutical) for blood pressure control. L.R.'s physician asks you about this possibility. He also asks you to recommend an alternative drug (to nisoldipine) for L.R.'s hard-to-control hypertension. She currently takes valsartan (Diovan, Novartis) 320 mg, hydrochlorothiazide (HCTZ) 50 mg, plus nisoldipine 20 mg/d. Her BP averages 145/90. Her only other medicine is prednisone 2 mg. What do you recommend?

Since cancer is the No. 1 area for drug research, it's no coincidence that more than 400 targeted compounds are in development and scores were touted at the recent annual meeting of the American Society of Clinical Oncology (ASCO) in Atlanta. Below is a sampling of promising new or improved cancer fighters:

The Food & Drug Administration recently approved the fentanyl iontophoretic transdermal system (IONSYS, Alza Corp.), the first needle-free, patient-activated transdermal analgesic (PATS) system. IONSYS is indicated for the short-term management of acute postoperative pain in adult patients requiring opioid analgesia during hospitalization. Alza said that it expects to start distributing IONSYS in 2007.

USP wants input from healthcare practitioners and other interested parties regarding the proposed revisions.

Medication reconciliation is back on the front burner. The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) has expanded its existing National Patient Safety Goal on medication reconciliation for 2007.

Most of the affected individuals are older females with hypertension who are being treated with agents known to affect renal perfusion.

Most drug manufacturers are turning thumbs down on a new opportunity to provide inpatient drug discounts to safety-net hospitals. According to a Public Hospital Pharmacy Coalition report, hospitals are getting the optional discount on just 12% of brand-name drugs purchased for inpatient use. "Some companies have stepped up to the plate," said PHPC executive director Ted Slafsky, "but most have not."

A new generic injectable autosubstitution program, recently launched by Premier Inc., is helping hospitals to save almost $3 million annually. The Charlotte, N.C.-based group purchasing organization (GPO) has signed up 300 of its member hospitals for the new program that provides an average savings of 5% off Premier's contract pricing.

Competition has finally come to closed-system drug transfer devices for hazardous drug products. Cardinal Health received clearance from the Food & Drug Administration to market Texium, a closed male luer that mates with the company's SmartSite needle-free products. Cardinal's new product is the first U.S. competitor to Carmel Pharma's PhaSeal system, introduced in the 1990s.

Delivering chemo agents intraperitoneally is extending survival

Making sense of Medicare Part D prescription drug plans has been a major challenge for seniors. But for Medicare Part D recipients who have received organ transplants, choosing a plan is the least of their problems.

Can a 100-bed hospital reduce medication errors and improve patient safety by increasing its pharmacy's hours and placing pharmacists in direct contact with patients? In January, the Garden Grove (Calif.) Hospital accomplished this feat by implementing a medication reconciliation program without increasing the pharmacy's budget.

Reactions from health-system pharmacists to proposed rule changes regarding the Inpatient Prospective Payment system (IPPS) can best be described as cautiously optimistic.