@ Medication Use

Hospitals increasingly are turning to technology as a potential cure for medication errors.

Aultman Hospital in Canton, for example, is embracing automation to fill prescriptions with its new $5.7 million pharmacy.

The recently opened state-of-the-art department features a new robot stocked with unit doses of 400 of the most commonly prescribed medications.

After receiving the order electronically, the robot zips into action, picks the individually wrapped single doses and stuffs them into an envelope to be delivered to the patient.

Another 2,000 medications are stocked in a new carousel, which rotates to the location of the prescribed medication after the pharmacy technician scans the patient order.

Each dose is tagged with a bar code, which can be scanned when the order is filled and then again when the drug is administered to verify the right patient gets the right medicine.

The hospital started rolling out the bar-code system this month. It allows nurses to scan the patient's bar-coded wristband along with the medicine's bar code as an added safety check and documenting tool, said Mimi Gozdan, Aultman's clinical informatics specialist.

 

The information then is added to the patient's electronic medical record.

It's a much simpler and more accurate way than paper charts to track the estimated 10,000 units of medication dispensed at the hospital each day, Gozdan said.

WASHINGTON, DC, March 2, 2009 – One-third of Americans are losing sleep over the state of the U.S. economy and other personal financial concerns, according to a new poll released today by the National Sleep Foundation (NSF). The poll suggests that inadequate sleep is associated with unhealthy lifestyles and negatively impacts health and safety.

NSF’s Sleep in America^™ poll reveals striking disparities in the sleep patterns, health habits and quality of life between healthy and unhealthy Americans. Those in good health are two-times more likely than those in poor health to work efficiently, exercise or eat healthy because they are getting enough sleep.

The number of people reporting sleep problems has increased 13% since 2001. In the past eight years, the number of Americans who sleep less than six hours a night jumped from 13% to 20%, and those who reported sleeping eight hours or more dropped from 38% to 28%.

“It’s easy to understand why so many people are concerned over the economy and jobs, but sacrificing sleep is the wrong solution,” says David Cloud, CEO of the National Sleep Foundation. “Sleep is essential for productivity and alertness and is a vital sign for one’s overall health.”

April 23, 2009 — Relatively low dietary intakes of vitamins A and C are associated with statistically significant increased odds of asthma and wheeze, according to the results of a systematic review and meta-analysis reported in the April 16 Online First issue of Thorax.

"Epidemiological studies suggest that dietary intake of vitamins A, C and E may be associated with the occurrence of asthma," write S. Allen, from the University of Nottingham in Nottingham, United Kingdom, and colleagues. "However, randomized controlled trials of vitamin supplementation in asthma thus far have been inconclusive. In view of this apparent inconsistency between the observational and experimental data, we have attempted to determine the magnitude of the overall associations of these vitamins estimated by the observational studies by carrying out a systematic review and meta-analysis to provide pooled quantitative estimates of the likely magnitude of the effect of dietary intake and blood levels of antioxidant vitamins on a range of measures of asthma and asthma severity."

The reviewers searched MEDLINE, EMBASE, CINAHL, CAB abstracts, and AMED up to November 2007 for studies of asthma, wheeze, or airway responsiveness in association with dietary intakes and serum concentrations of vitamins A, C, and E. Conference proceedings and bibliographies of identified studies were also searched. Random-effects models allowed estimates of pooled odds ratios (ORs) or mean differences (MDs) with 95% confidence intervals (CIs).

CHICAGO - The American Medical Association is developing a Web-based service offering doctors electronic prescribing, up-to-date reference material and other resources.

The idea is to make it easier for physicians to adopt technology President Obama is promoting for health care reform, to streamline their workload, and improve patient care.

The service is being pilot-tested, and will be offered to doctors nationwide early next year through a deal announced Wednesday with Compuware Corp.

"With a single click to log on," doctors will be able to access numerous electronic medical services, including the latest science on diseases, and electronic health records, said Dr. Joseph Heyman, chairman of the AMA's board.

WellStar's GSA keeps "operations" running smoothly

Congrats to Rob and the Web team at WellStar in Atlanta, Georgia. Here's their story:

Before GSA: With five premier hospitals in the Northwest suburbs of Atlanta, 11,000 employees and the largest nonacademic Physicians Group in the State,WellStar Health System has become one of the biggest not-for-profit health care systems in the Southeast. As WellStar grew, it became increasingly difficult for folks to find our stuff. WellStar’s intranet houses a physician portal containing content from over 70 different clinical sites – along with unique portals for 60+ supporting enterprise departments – andeveryone's generic material permeated our content management systems (CMS ). Employee and patient volumes intensified, organically creating a nightmare of a file library, and it seemed that our system needed 20CCs of Findability Stat! The challenge was to efficiently serve everyone at once while minimizing the impact on our own busy environment.

After GSA: Our previous intranet search limited employees to each of our internal .Net portals, meaning employees would have to be sifting through the right haystack to find a specific needle, which gave them a whopping 1.4% chance of starting in the right place. This all changed with the GSA. The GSA crawls from a central location and provides a single URL to hit when employees need fast results. Its active replacement of cached, dead-end links diminishes wasted search time, and the “Text Only” document display feature is an essential business asset for clinical employees without specific readers.

After purchasing the GSA and performing a minimal setup, our team found that the appliance was pulling several hundred rabbits out of its hat every eight hours. It was finding the one-of-a-kind policy, form, safety, and class information details from long forgotten documents – all without requiring someone to organize the material. Thin-air content was rediscovered, removed, and replaced with current information, and incoming help calls starting with “Where do I find…” have been eliminated.

In a follow-up to Dr. Flynn’s commentary, John Poikonen, PharmD, director of clinical informatics at University of Massachusetts Memorial Medical Center, in Worcester, agreed that study is needed. Writing in the April 15 issue of AJHP (2009;66:704-705). Dr. Poikonen urged the design of a study “to assess the patient-safety effects of eliminating NUPOR on certain orders.” 

He stressed that cutting NUPOR would not be appropriate for chemotherapy or other high-risk medications, but rather for a “ ‘sweet spot’ of medications that can be safely and effectively reviewed electronically without pharmacist review.”

Dr. Maddux agreed that in certain settings, prospective order review can be valuable, particularly “in cases where patients and therapy are complex.” But, he added, in other situations, such as when CPOE and/or standardized order sets are used, “you are committing pharmacists to reviewing orders that have already been vetted and standardized.”

A better approach, according to Dr. Maddux, is to have more pharmacists on clinical teams actively involved in patient management at the bedside and in the clinic. “Prospective review at the time of the order may be more beneficial,” he said. If a pharmacist is involved on the clinical team caring for the patient, and “a suboptimal order is avoided to begin with, then there is no need for a pharmacist to go through all that review later,” when he or she may or may not have access to all the relevant information required to make the most informed decision regarding the order.

While recognizing the importance of order entry review, Dr. Maddux stressed that “there could be improvements; NUPOR, in and of itself, for all comers, may not be the best way to go.”

Great article summarizing the interesting discussion that Dr. Poikonen recently prodded into the limelight.

Also nice to see the quote(s) from Dr. Maddux - the former clinical Dean from my alma mater - and his well-worded statement on the issue.

The recently enacted stimulus bill — the American Recovery and Reinvestment Act of 2009 (ARRA) — touches almost every aspect of the U.S. economy. Health care is no exception. In fact, the ARRA is historic health care legislation of the type rarely produced by our famously incremental federal government. The law prevents dramatic state cuts in Medicaid, expands funding for preventive health care services and health care research, and helps the unemployed buy health insurance. But perhaps its most profound effect on doctors and patients will result from its unprecedented $19 billion program to promote the adoption and use of health information technology (HIT) and especially electronic health records (EHRs).

The HIT components of the stimulus package — collectively labeled HITECH in the law — reflect a shared conviction among the fledgling Obama administration, the Congress, and many health care experts that electronic information systems are essential to improving the health and health care of Americans. However, proponents of HIT expansion face substantial problems. Few U.S. doctors or hospitals — perhaps 17% and 10%, respectively — have even basic EHRs, and there are significant barriers to their adoption and use: their substantial cost, the perceived lack of financial return from investing in them, the technical and logistic challenges involved in installing, maintaining, and updating them, and consumers' and physicians' concerns about the privacy and security of electronic health information. HITECH addresses these obstacles head on, but huge challenges await efforts to implement the law and fulfill President Barack Obama's promise that every American will have the benefit of an EHR by 2014.

"People think that the first draft is the big event and that revision is cleaning up afterward. But the first draft is really setting up the chairs, tables, and cups, and revision isn't cleaning up after the party, it is the party."

"All first drafts are terrible. I don't care if you're Hemingway."

"What comes out unfiltered from anyone's mind is mud."

The first two quotations come from writing professors whose names I've since forgotten (and they were quoting other people whom they'd forgotten). The last one is one I just made up myself. But regardless of the source, the advice is sound: no email should be clicked-to-send without revision.

Sound advice considering this is the contemporary communication medium of choice.

Now, hospitals in Wisconsin that have adopted the system use a red band to denote allergy, a yellow one for fall risk, and a purple band to indicate a do-not-resuscitate (DNR) status, according to the Wisconsin Hospital Association (WHA), which led the initiative. A white or clear wristband is used for patient-identification information.

The Pennsylvania-based Institute for Safe Medication Practices (ISMP) in 2006 called for national standardization of wristband alert colors. ISMP made the recommendation after a near-miss incident in Pennsylvania where a nurse placed a yellow wristband on a patient, thinking it signaled a restriction against performing procedures on that arm, at a hospital where the color indicated a DNR status.

A group of Pennsylvania hospitals subsequently launched a wristband standardization project that has earned recognition from the federal Agency for Healthcare Research and Quality. The Pennsylvania project specifies the use of blue bands for DNR, red for allergy, and yellow for fall risk. Implementation tools have been created to help other states to craft their own programs.

Walgreens pharmacies filled a record 3.1 million prescriptions electronically in March, about 15 percent of all the drugstore chain's eligible prescriptions and a 211 percent increase compared with March of last year.

Walgreens estimates it will fill more than 40 million electronic prescriptions this year compared with 15 million filled in 2008. The company expects growth to continue, as the federal government in January began providing financial incentives for doctors to transmit prescriptions electronically for Medicare patients. In exchange, the doctors will earn a 2 percent bonus on their covered Medicare reimbursements.

Also, the recently signed federal stimulus package should sharply bolster electronic prescribing throughout the United States by providing $36 billion in incentives to clinics and medical offices to adopt electronic health records. A core component of the upgraded technology will allow doctors access to software that makes electronic prescribing possible.


Source
Walgreens