Health System

Health-system pharmacists have enough on their plate with clinical issues. But, like it or not, many pharmacists are starting to pay closer attention to revenue cycle and billing concerns. And if they're not, they'd better start. At least that's the advice from some industry experts.

Where there is crisis, there is also opportunity, and one Wichita, Kan., pharmacist sees plenty of that. Only a handful of Kansas hospitals can afford 24-hour pharmacy service. "Once the day-shift pharmacist goes home, many hospitals have a tech or a nurse taking over," Mark Gagnon said. "They don't want to do the pharmacist's job, but what do you do when there's no pharmacist until tomorrow or even next Monday?"

Mercy Hospital, Miami, Fla., is using discounted Rxs to lure patients into a preventive healthcare program. The hospital estimates that 4,000 patients saved an average of $140 for the 10,000 program prescriptions filled during the first quarter of 2005.

Hospitals often take a financial beating when they do not get adequately reimbursed for certain high-priced, lifesaving drugs. But thanks to a new diagnostic code for stroke patients, which goes into effect on Oct. 1, 2005, reimbursement for critical clot-busting drugs (thrombolytics) will be more equitable.

Significant deviations from good manufacturing processes in repackaging and relabeling active pharmaceutical ingredients are what the Food & Drug Administration cited in a letter sent to Pragmatic Materials Inc. in June. During site visits in February, the agency found that the company, which repackages ingredients for use by pharmacies for compounding drug products, had not performed the appropriate tests to support the expiration dates assigned to at least six ingredients. Violations such as these can ignite fear and concern in hospital pharmacists and administrators who are outsourcing their sterile or nonsterile products to compounders to save staff time, cut hospital costs, and comply with new regulations.

CMS. HQA. ASHP. Leapfrog Group. NQF. JCAHO. AHQA. VA. AHRQ. The list of regulators, professional associations, government agencies, payers, consumer groups, and others that claim to set standards for health care seems to grow daily. Every new standard, every new information request, every new effort to assess or improve quality adds to the hospital administrative burden.

Hospitals and pharmacies will be adding radio frequency identification (RFID) tags in the years ahead to curb drug counterfeiting. What is RFID? According to the Association for Automatic Identification and Mobility (AIM), a basic radio frequency identification, or RFID, system consists of three components: an antenna or coil, a transceiver (with decoder), and a transponder, which is also called an RF tag and is electronically programmed with unique information.

Many wonder whether the focus of genetically directed pharmacotherapy should be tied to race at all. According to the Nuffield Council on Bioethics, race and ethnicity cannot be given precise biological or genetic definitions because of the considerable genetic variation within population groups depending on the patient's place of birth and other variables.

The Centers for Medicare & Medicaid Services wants to change the way it pays for drugs administered by hospital outpatient services. Starting in 2006, CMS proposes to pay hospitals the average sales price (ASP) plus 8% under the Outpatient Prospective Payment System (OPPS).

Beta-blockers are the top choice for prevention of postoperative atrial fibrillation (AF) and control of ventricular rate, according to the first evidence-based clinical guidelines for the prevention and management of postoperative AF after cardiac surgery, published recently by the American College of Chest Physicians (ACCP).

A 35-year-old patient, C.A., with a mechanical heart valve, has had an INR of 2.5 to 3.5 for several years while on warfarin therapy. Today, at her visit to your anticoagulation clinic, she confides that she is six weeks' pregnant.

Heart failure (HF) is a major health problem and a leading cause of hospitalizations among the elderly. Keeping pace with the new treatment approaches, the American College of Cardiology (ACC) and the American Heart Association (AHA) task force recently released updated Guidelines for the Diagnosis and the Management of Chronic Heart Failure in the Adult.

Several articles, published over the past several years, have demonstrated the benefit of clinical pharmacy rounding in intensive care units. Benefits documented include improved quality of care as well as cost savings to the institutions. Our health system recently added clinical pharmacists to patient rounding and found that it has improved our patients' outcomes.

Reactions throughout the health-system pharmacy community have been overwhelmingly favorable regarding the new federal legislation that would protect medical error information from being used against healthcare practitioners who report adverse events and medication errors.

For many years, sublingual (SL) nitroglycerin has been used as part of the standard of care in the management of acute anginal episodes. Traditionally, patients prescribed SL nitroglycerin were advised to promptly dissolve one tablet under the tongue or in the buccal pouch at the first sign of an anginal attack.

Hospitals are seeing the advent of a new generation of systems in the context of computerized physician order entry (CPOE) that are more user-friendly and yield a quicker return on investment (ROI). Several products have evolved in the marketplace. These products are called Paperless Pharmacy Order Systems (PPOSs). They provide a paperless environment in pharmacy and a work-flow engine between pharmacists and clinicians.

Automation governs medication-dispensing systems in many health systems, enhancing safety and efficiency-as long as the computers that operate the systems don&t crash. A growing trend in automation aggressively addresses this problem by allowing vendors to remotely monitor automation computer servers in real time, preventing crashes before pharmacists even know there&s a problem.

Given that errors involving intravenous medications may carry the greatest risk of morbidity and mortality, health professionals are welcoming the advent of smart pumps with programmable safety features that alert hospital staff to potential errors in IV infusions. Implementing such systems involves getting technology vendors, along with pharmacy, nursing, and medical staffs, to communicate with each other so that infusion systems and medical records systems work together.

At Saint Francis Hospital and Medical Center in Hartford, Conn., the pharmacy department has been ahead of the technology curve for quite some time compared with most other hospitals. That's evident from a visit Drug Topics editors paid recently to the hospital.

Patients taking the blood-thinning medication warfarin have fewer complications when managed by a specialized anticoagulation service than do those who receive usual care from their physicians. That was a finding of a study conducted by Kaiser Permanente's Clinical Pharmacy Anticoagulation Service.

Of the 1,100 public hospitals that treat a disproportionately large share of indigent patients and that are eligible to participate in the federal government's 340B drug discount program, about 700 are not enrolled. This means that up to 63% of disproportionate share hospitals (DSHs) are not taking advantage of potential discounts.

Patients requiring immune globulin (IG) are finding the therapy difficult to acquire because of tightening supplies of the plasma-derived biologic and new, lower Medicare reimbursements, according to patient groups and industry analysts.

New guidelines for the management of heart transplant patients are coming from the International Society for Heart & Lung Transplantation (ISHLT). "The last version of the currently advocated guidelines was approved in consensus form in 1992," said Mandeep Mehra, M.D., an ISHLT board member and the head of the division of cardiology at the University of Maryland School of Medicine in Baltimore. "Since that time, the management of congestive heart failure [CHF] has changed dramatically," he said.

A 75-year-old woman, G.D., is in the ER for chest pain that has now been diagnosed as heartburn. She is given lansoprazole (Prevacid, TAP) samples. Five months ago she had an acute myocardial infarction (MI) with stent placement. She was discharged on a daily regimen of clopidogrel (Plavix, Sanofi-Aventis) 75 mg, aspirin 80 mg, ezetimibe (Zetia, Merck/Schering-Plough) 10 mg, atorvastatin (Lipitor, Pfizer) 20 mg, sublingual nitroglycerin, metoprolol timed-release 50 mg, and valsartan (Diovan, Novartis) 160 mg.

This year's American Academy of Neurology (AAN) meeting featured key drug trials for diseases ranging from epilepsy to Alzheimer's disease (AD) to multiple sclerosis (MS). About 1% of all children up to the age of 16 are affected by epilepsy. Despite broadened and improved pharmacologic options, about 25% of these are refractory to standard therapy. Oxcarbazepine (Trileptal, Novartis), a newer antiepileptic drug (AED), has been assessed and found to be safe and effective both as monotherapy and adjunctive therapy in children.

Donald Goldmann, M.D., who has studied antibiotic resistance for 20 years, said community-acquired methicillin-resistant Staphylococcus aureus (MRSA) is infiltrating hospitals and "it is a pandemic that will not be controlled. It is going to fundamentally alter how we use antibiotics and how we attempt to control them."

Pharmacists play a critical role in ensuring patient safety. They detect and report medication errors, counsel patients, and educate other healthcare personnel. But two common communication problems?lack of a shared definition of error and of agreement as to the role and scope of the pharmacist's work?coupled with inadequate access to resources for managing the pharmacy workload prevent R.Ph.s from fulfilling their key role.

Acquisitions, integration, and point-of-care strategies were dominant technology themes at the 2005 ASHP Summer Meeting in Boston in June. Topping the headlines was Cerner Corp.'s acquisition of Bridge Medical Inc. The $11 million deal will substantially expand Cerner's presence in the bar-code market at a time when pressure from regulatory agencies is driving hospitals to reduce medication errors.

Curing non-Hodgkin's lymphoma (NHL) is a formidable task, but clinicians and researchers are rapidly assembling the tools to do it. Over the past decade, our understanding of the disease process has progressed to the molecular level?allowing the development of new therapeutic options with the potential to precisely target therapy to the lymphomas?paving the way for longer remissions; fewer side effects; and, for increasingly more patients, cures. Research is progressing at a dizzying pace?at least 200 U.S. clinical trials are enrolling NHL patients.