Health System

Like a Turkish bazaar, the exhibit floor of the recent ASHP midyear conference, drawing an eye-popping attendance of 20,000 registrants, showcased many new products for health-system pharmacists. Here are some of the new wares displayed at the Las Vegas show

Reducing medical errors during total parenteral nutrition (TPN) processes has been a 25-year challenge for Robert Poole, Pharm.D., director of pharmacy, and his colleagues at Lucile Packard Children's Hospital (LPCH), Stanford University Medical Center.

A two-year effort designed to improve patient safety in Michigan intensive care units has driven down mortality and length of stay by boosting involvement of intensivists in daily rounds, improving reporting, and implementing interventions designed to cut bloodstream infections and ventilator-related pneumonias.

If your hospital is not using a closed-loop medication management system, it soon will be. That's the prediction from the Fourth Annual Summit on Patient Safety & Information Technology held in San Francisco last month. Bar-coding, radio frequency identification (RFID), computerized physician order entry (CPOE), and other elements of a closed-loop medication system are moving at different speeds in similar directions.

An aggressive program of psychotropic drug prescription management saved the Missouri Medicaid program $7.7 million in fiscal 2004. Named Behavioral Pharmacy Management (BPM), the program analyzed drug claims—including inpatient psychotropic prescriptions— to identify inappropriate prescribing patterns.

Some medical errors are so egregious that lawmakers in four states now require hospitals to publicly report how often they occur, and to prove that they have taken corrective action. These "never events" laws adopted in Illinois, Minnesota, New Jersey, and Connecticut are based on criteria developed by the National Quality Forum (NQF).

To catch a thief

A 55-year-old African-American man, T.F., presents to your ER with headache, fever (102?F), muscle aches, and cough; his symptoms have rapidly worsened since onset (24 hours). T.F. received the inactivated influenza immunization 10 days earlier but is diagnosed with influenza A. T.F. had a renal transplant several years ago. His current medicines include tacrolimus (Prograf, Astellas Pharma), prednisone, mycophenolate mofetil (MMF) (CellCept, Roche), and furosemide 40 mg daily. T.F.'s SrCr51.8. The resident is considering antiviral therapy and asks your opinion. What do you suggest?

Percutaneous coronary intervention (PCI) encompasses a variety of procedures, including percutaneous transluminal coronary angioplasty (PTCA), intracoronary stenting, and atheroablative technologies used to diagnose and treat patients with coronary artery syndromes such as heart attacks and angina. In the United States, more than one million PCI procedures are performed annually, and it is estimated that about two million procedures are performed annually worldwide. Patients undergoing PCIs are at risk for developing blood clots in the coronary artery, which can result in a variety of complications including heart attack, emergency surgery, and even death.

Hospitals and health systems accredited by the Joint Commission on Accreditation of Healthcare Organizations are getting ready for the first truly unannounced, no-appointment-necessary, on-site surveys. Under the new policy, JCAHO surveyors can show up anytime between Jan. 1, 2006, and Dec. 31, 2006. The only warning facilities will get is a 7:00 a.m. e-mail notification on the morning of the survey.

While there was no "stop-the-presses" news to come out of the 40th ASHP Midyear Clinical Meeting and Exhibition in Las Vegas last month, which drew a record-setting 20,000 registrants, several themes emerged that clearly resonated with attendees.

When pharmacy director Steve Sievert needs to talk to someone at Baptist Medical Center South (BMCS) in Jacksonville, Fla., he doesn't bother with the telephone. He just tells the Vocera hanging around his neck. The tiny wireless communications device either finds the person somewhere on the hospital campus or routes the request to voice mail.

Preparing for rounding with your team, you check some patient data.

A revolution in the pharmacologic treatment of hypertension is under way, according to experts reporting at a conference called "The State of the Hypertension Nation," held recently in New York City. Here are some highlights from the conference.

After three recent deaths—each linked to medication administration errors—at two California Kaiser Permanente hospitals, the organization has taken aggressive measures to prevent these types of horrific mistakes.

A patient safety initiative that emphasizes the importance of evidence-based protocols to fight hospital-acquired infections won recognition recently from the Joint Commission on Accreditation of Healthcare Organizations.

A pharmacist-led multidisciplinary team at Evanston (Ill.) Northwestern Healthcare (ENH) has earned for the health system the 2005 Award for Medication-Use Safety.

In a timely marriage of technology and data, RxHub and Siemens Medical Solutions recently signed an agreement to provide outpatient medication records electronically to inpatient clinicians. The move takes place in anticipation of the medication reconciliation patient safety goal set this year by the Joint Commission on Accreditation of Healthcare Organizations for implementation in the nation's hospitals in January 2006.

A new wireless medication management system from Cerner and Hospira may significantly reduce intravenous pump errors. The new system integrates Cerner's bar-code point-of-care (BPOC) system with Hospira's smart pump to ensure that the right patient is getting the right dose of the right drug at the right time by the right route of administration.

When pharmacy director Steve Sievert needs to talk to someone at Baptist Medical Center South (BMCS) in Jacksonville, Fla., he doesn't bother with the telephone. He just tells the Vocera hanging around his neck. The tiny wireless communications device either finds the person somewhere on the hospital campus or routes the request to voice mail.

Though blockbusters that wreak havoc on budgets are not anticipated, some new agents still bear watching.

In a move to expand efforts to control hospital-acquired infections, the Pennsylvania Health Care Cost Containment Council (PHC4) recently awarded grants totaling $150,000 to six state hospitals. The hospitals will use the money to implement projects to reduce the number of surgical-site infections, Foley catheter-associated urinary tract infections, ventilator-associated pneumonia and central line-associated bloodstream infections, and ventriculostomy and/ or medically resistant staphylococcus infections, said PHC4 officials.

In a move to expand efforts to control hospital-acquired infections, the Pennsylvania Health Care Cost Containment Council (PHC4) recently awarded grants totaling $150,000 to six state hospitals. The hospitals will use the money to implement projects to reduce the number of surgical-site infections, Foley catheter-associated urinary tract infections, ventilator-associated pneumonia and central line-associated bloodstream infections, and ventriculostomy and/ or medically resistant staphylococcus infections, said PHC4 officials.

The government agency responsible for overseeing the 340B Drug Discount Program again has the power to access data on the drug prices charged to healthcare providers who serve underprivileged communities, following an intervention by Senator Chuck Grassley (R, Iowa).

Having trouble rationalizing the use of popular but off-label critical care agents? A special session at the American College of Clinical Pharmacy's annual meeting explored evidence for the use of vasopressin, Factor VIIa, intravenous proton pump inhibitors, and dexmedetomidine (Precedex, Abbott Laboratories).

An exclusive survey of nurses reveals they hold pharmacists in high regard

Hospitals that make use of ForHealth's IntelliFill i.v. system can now package injectable drugs for prescription compounding in Samson Medical Technologies' SmartPak Reservoir Bags. These are sealed plastic bags in a foil overwrap that can contain up to 300 gm of sterile powder. ForHealth Technologies has reached an agreement with Samson to make this possible.

Supporters of the notion that apologies are better than malpractice lawsuits got a boost in late September. Sens. Hillary Rodham Clinton (D, N.Y.) and Barack Obama (D, Ill.) introduced the National Medical Error Disclosure and Compensation (MEDiC) Act to encourage hospitals to apologize after medical errors and negotiate fair compensation.

A new project in mid-Atlantic region hospitals puts the spotlight on reconciling medications for intensive care unit (ICU) and operating room patients. As part of a nationwide "100,000 Lives and Beyond" Collaborative, pharmacists who care for patients in Delaware, Maryland, Northern Virginia, and Washington, D.C., hospitals beginning in January 2006 will have the opportunity to formalize processes for getting a complete and accurate list of each patient's current home medications, including name, dosage, frequency, and route and comparing them to the physician's admission, transfer, and/or discharge orders.

At Sentara Healthcare in Norfolk, Va., an aggressive program borrowed from the nuclear energy industry recently won the health system a prestigious patient safety award. Called "Culture of Safety," the program focuses on what its practitioners call behavior-based expectations (BBEs), or "Red Rules," emphasizing communication and accountability.