Health System

Nationwide drug shortages, many of which are caused by manufacturing problems, often leave hospital-based healthcare professionals in a bind. A few years ago, when Wyeth-Ayerst announced the imminent unavailability of hyaluronidase (Wydase), it sent shock waves throughout the hospital community.

Because only some states now require hospitals to report their healthcare-associated infection (HAI) rates, while others don't, the Centers for Disease Control & Prevention is considering helping states develop policies to obtain this information. Lending support to this initiative is consumer demand for the public disclosure of HAI data.

Noncompliance with antirejection drug regimens is the cause of many transplant failures each year. To help transplant patients prepare for their surgery and adhere to their medications, a new mentor program has been established. The program pairs current transplant candidates with former patients as mentors, in an attempt to facilitate transplantation, before and after surgery.

For Randy Carver, R.Ph., it was baptism by fire. Carver, the pharmacy automation coordinator at Phoebe Putney Memorial Hospital in Albany, Ga., learned his technology skills on the job, beginning back in 1995 when the hospital installed its first unit-based cabinet in the emergency department. "When I came on board, I didn't know anything about automation. I had no formal computer training, I had to learn everything," he said.

Chest pain is exceeded only by abdominal pain as the reason people visit their local emergency department. The American Heart Association (AHA) estimates that 6.8 million Americans have chronic stable angina (CSA). In 1999, the American College of Physicians (ACP) and the American College of Cardiology (ACC) and AHA developed joint guidelines on the management of patients with CSA. ACC/AHA updated these guidelines in 2002, and ACP recognized the document as a scientifically valid, high-quality review of the evidence and background paper.

At the American Association for Cancer Research (AACR) Seattle meeting in October, researchers focused on prevention strategies for cancer. Presenters were particularly excited about the potential for new combination therapies to prevent colorectal cancer.

Because only some states now require hospitals to report their healthcare-associated infection (HAI) rates, while others don't, the Centers for Disease Control & Prevention is considering helping states develop policies to obtain this information. Lending support to this initiative is consumer demand for the public disclosure of HAI data.

Once referred to as "miracle drugs" for their ability to eradicate infection and save countless lives, antibiotics are losing their battle against resistant organisms, and no fresh supply of novel drugs exists. Unless antibiotic research and development is reinvigorated soon, a public health crisis is imminent.

A: Dyslipidemia is a well-known risk factor for coronary heart disease (CHD). Although decreasing low-density lipoprotein cholesterol (LDL-C) levels has long been the primary objective of the management of this disorder, emphasis has also been placed on finding new therapeutic targets as a means to further decrease cardiovascular risk, including agents that raise high-density lipoprotein cholesterol (HDL-C). Low HDL-C, which was previously defined as < 35 mg/dl but recently changed to < 40 mg/dl, is classified as a major risk factor for CHD, whereas high HDL-C (? 60 mg/dl) is beneficial and considered a negative risk factor.

Malignant lymphoma, including Hodgkin's disease and the non-Hodgkin's lymphomas (NHLs), afflicts more than 50,000 persons and results in almost 20,000 deaths annually in the United States. Unfortunately, the findings of a recent study indicated that 48% to 53% of patients with NHL receive a relative dose intensity (RDI) less than 85% of the minimum six-cycle and National Comprehensive Cancer Network guideline standards. Study investigators also found that the RDI of less than 85% was planned in 37.9% of patients.

Once referred to as "miracle drugs" for their ability to eradicate infection and save countless lives, antibiotics are losing their battle against resistant organisms, and no fresh supply of novel drugs exists. Unless antibiotic research and development is reinvigorated soon, a public health crisis is imminent.

To prevent the administration of excessive amounts of analgesia medication, patient-controlled analgesia (PCA) pumps offer several safety features (e.g., a "lockout interval" specifies both the minimum amount of time between each dose and an established maximum allowable amount of drug during a predefined time period). Despite such advantages, medication errors involving PCA pumps continue to occur.

A pilot project examining the value of incorporating electronically transmitted patient claims data into a health-system medication dispensing process has been pronounced a success by the hospital that implemented it.

The Joint Commission on Accreditation of Healthcare Organizations has begun a study to examine the types of counseling hospitals offer patients to help them quit smoking. The goal of the study is to identify and evaluate strategies hospitals can use to help patients who smoke to kick the habit.

Institutional pharmacists should get ready for more intensive scrutiny of their operations next year. Half of the 2005 National Patient Safety Goals (NPSGs) set by the Joint Commission on Accreditation of Healthcare Organizations are directly related to pharmacy.

Can a hospital reduce patients' risks and cut costs by hiring a pharmacist to focus on potential errors during transitions from ambulatory to inpatient care and back again? Two-thirds of postdischarge errors are medication mistakes, according to a study in Annals of Internal Medicine last year. In light of that and similar findings, Providence Health System is running a randomized trial at its Portland Medical Center to examine the worth of a transitional pharmacist.

This was not the news that group purchasing organizations (GPOs) wanted to hear. The Medical Device Competition Act of 2004, introduced in the Senate earlier this month, would mandate that Health & Human Services oversee the GPO industry as a way to prevent groups from engaging in anticompetitive or unethical practices. The bill-S. 2880-would also direct HHS to write rules forbidding such behavior, bar GPOs from receiving vendor fees without HHS certification of their compliance with the rules, and limit vendor fees to 3% of the price of goods and services sold.

Internet-based paperless pharmacy order management can improve efficiency and enhance patient safety, according to its proponents. "We were determined to get away from paper orders," said Joe Hoffmann, Pharm.D., pharmacy director at 245-bed Wuesthoff Hospital in Rockledge, Fla. "So we searched for something, and what we found is working very well."

The Institute for Safe Medication Practices celebrates its 10th anniversary as a nonprofit organization this year. ISMP was established to educate the healthcare community about safe medication practices in order to reduce the threat of medication errors. The institute is also involved in a wide range of projects and services, including publishing medication safety newsletters, holding educational conferences, and providing on-site consulting to hospitals. ISMP has advo-cated for improvements in drug names, labeling, packaging, technology, and medication practices to reduce the risk of medication errors.

The changing and increasingly important role of the pharmacist in the healthcare system, whether in the hospital setting, managed care, or community pharmacy, was the focus of much of the recent Federation Internationale Pharmaceutique (FIP) annual meeting in New Orleans. Speakers noted that pharmacists have already become more responsible for pa-tient education, and, in the future, their roles would shift even further from dispensing to collaborating with physicians to ensure optimal patient outcomes through the proper usage of medications.

The Medicare quality improvement organization (QIO) IPRO in Lake Success, N.Y., has contacted 22 hospitals in downstate New York to learn what the facilities have been doing to reduce their rate of surgical site infections. It found that assertive action by health-system pharmacists has enhanced patient safety by improving the timeliness of antibiotic prophylaxis.

According to the American Heart Association, between 600,000 and one million Americans are affected by deep vein thrombosis (DVT) annually. As many as 200,000 will die of pulmonary embolism (PE), which is more than from breast cancer and AIDS combined.

A 72-year-old man, L.Z., has been admitted to your hospital via the ER. On admission, he was combative and agitated, and he was treated with intramuscular lorazepam. According to his wife, he has Alzheimer's disease and has become increasingly verbally and physically abusive. His medications include atorvastatin (Lipitor, Pfizer) 10 mg q.d., glipizide XL 5 mg before meals, and rivastigmine (Exelon, Novartis) 6 mg b.i.d. with meals. Oral lorazepam was initiated at a dose of 1 mg b.i.d. L.Z.'s physician asks you which antipsychotic drug you would suggest adding to this regimen. How do you respond?

Obesity, atrial fibrillation/flutter, and diabetic nephropathy, which are clearly on the rise worldwide, were the key areas of attention at the European Society of Cardiology 2004 annual meeting, held in Munich, Germany, recently.

In 2004, one of the National Patient Safety Goals released by the Joint Commission on Accreditation of Healthcare Organizations focused on improving safety when using high-alert medications, such as paralytic agents.

Who are the shining lights among independent pharmacies for 2004? Once again, Drug Topics invited wholesalers across the country to nominate their independent pharmacy customers who have done a superlative job of providing pharmacy and nonpharmacy services, merchandising or promoting their stores, overcoming competition, and handling crises.

The prairie stone is a rock that is indigenous to Minnesota, and it is also the stone used to create the mortar and pestle. So when it came to naming their new Minneapolis-based pharmacy chain, the company's three partners found it a no-brainer. They dubbed it PrairieStone Pharmacy.

In 2003, more than 3.2 billion prescriptions were filled; that's an increase of more than 65% since 1992. This good news comes from the National Association of Chain Drug Stores Foundation's recently released 2004 Chain Pharmacy Industry Profile.

How is it going today?" This is a question that management likes to ask in the pharmacy. She walks in, uninvited, flashing a big smile. You know this is going to take up time you do not have. If you're lucky, she notices you are busy, waits patiently, and asks her question when you're between tasks.

A recent survey found that 14% of heart failure patients with prescription drug coverage chose not to fill an Rx in the prior year due to cost. Now the findings of a new survey suggest that many of the sickest patients do not tell their healthcare providers what they are doing. Cost-related medication underuse: Do patients with chronic illnesses tell their doctors? was published in the Sept. 13 issue of the Archives of Internal Medicine.