Articles Posted in Health Care Technology

In the old days, a pharmacist’s job hardly resembled what it does today. With hundreds of patients coming in to fill tens of thousands of prescriptions each month, the average pharmacist is extremely busy. This leaves them with little time to spend with each patient, and it may even result in the pharmacist rushing through important safety measures just to keep up with the workload.

Taking MedicationThe situation in hospital pharmacies is similar; with patients constantly being admitted and discharged, it can be difficult for pharmacists to keep all of the patients and medications straight. This has led hospitals across the country to rely more on technology. And it seems to be working in reducing Maryland pharmacy error rates and rates in other states.

According to a recent news article, the use of electronic health records (EHRs) and computerized prescriber-order-entry (CPOE) systems has greatly reduced the number of medication errors in hospitals nationwide. As a result, these systems have been widely adopted, with approximately 99% of hospitals using EHRs and 97% of hospitals using CPOE systems to fill at least some portions of the prescriptions filled in the hospital.

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When most hear that a pharmacy error was made, they assume that a busy pharmacist grabbed the wrong prescription, got the dosage information incorrect, or printed the wrong instructions. However, according to a recent industry news report, a large portion of pharmacy errors list information technology as a contributing factor to the error.

Assorted PillsAs health care technology advances, pharmacies are relying more and more on technology to fill in the gaps where humans are prone to making errors. These areas include patient records, dosage instructions, drug-interaction alerts, and receiving and inputting customer orders. In many cases, technology allows for fewer pharmacists to fill more prescriptions per day, which benefits both the pharmacy owner as well as the patient, who presumably will have reduced wait times.

As the report notes, however, technology is not perfect. According to the report, the most common errors involved the dosage of medication, including omitting the dose, including the wrong dose, or including an extra dose of medication in a patient’s prescription. While many of these errors will be caught before the patient ingests the medication, some of these errors will result in a patient’s injury.

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As business practices across the board evolve, so does the pharmacy industry. And with brick-and-mortar pharmacies requiring high month-to-month operating costs, mail-order pharmacies are becoming more common as a way for some patients to save money on their costly prescriptions. With the increase in popularity of mail-order pharmacies, more and more people are getting experience dealing with these companies, which do not present any opportunity for face-to-face interaction.

Medication SuppliesThe truth of the matter is that pharmacies – regardless of where they are based – have a duty to their patients to accurately fill all prescriptions. And if a mail-order pharmacy can save customers money on prescriptions by not needing to pay real-estate or rental costs, that is fine, but pharmacies should not cut corners when it comes to staffing or customer service. However, that is exactly what one woman experienced when trying to secure her husband’s necessary daily medications from one mail-order pharmacy.

According to a recent article by Forbes, customer service at some mail-order pharmacies may be so poor that it puts patients in danger of running out of necessary medication. The article details the plight of a woman whose husband had recently been diagnosed with Parkinson’s Disease. Aside from dealing with the life-changing realizations the diagnosis brought, the couple also had to find a way to ensure a steady supply of the husband’s extremely expensive day-to-day medications.

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When most people think of prescriptions, they think about their monthly trip to the pharmacy to pick up their medication. However, a large portion of the prescriptions written and filled each year in the United States originate and are delivered in hospitals. Each year, there are thousands of instances when a prescription is delivered in error to a patient at their bedside while in a hospital. For several years now, those involved in the health care industry have been searching for safer ways of delivering medication to patients.

pills-1153877-mAccording to a health care industry news source, some hospitals are implementing a new technology when delivering medication to their patients. The technology is called radio frequency identification (RFID), and it is what is used in drive-through toll booths that have become popular in recent years. The technology allows for a “proximity scan” to pick up information that is held in computer chips, called RFID chips. These RFID chips can hold all kinds of information, including a patient’s required prescriptions as well as their frequency and dose.

One of the hospital executives behind the push for the use of RFID chips explained to reporters that when humans are involved, there is always the potential for error. With the increasing use of technology, it is hoped that the instances of prescription drug errors will drop in the coming years.

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It seems that there really is an app for everything. In a recent article by DNA India, a new app is on the market targeted towards Indian physicians. The app, called Safe RX, is a way for doctors to put in prescriptions for patients that ensure the prescriptions are legible. In addition, the app automatically can translate the prescription into 14 different languages, further decreasing any chance of confusion.

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With the incidents of prescription error at an all-time high, apps like this one aim to fill a gap where oversight is minimal.

In addition to the safety aspects of the app, it will also automatically recommend generic equivalent for brand name prescriptions. This should help to keep medical costs down for people without insurance.

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The U.S. Food and Drug Administration (FDA) approved a “hand-held auto-injector” device for use with known or suspected opioid overdoses. Abuse of opioids, a group of drugs that includes many prescription painkillers, is becoming a serious problem in the U.S., and the FDA claims that opioid overdose has surpassed automobile accidents as the nation’s leading cause of injury deaths. The device, marketed under the brand name Evzio, delivers an injection of naloxone hydrochloride to counter or reverse the effects of opioid overdose. The FDA has stated that it hopes the availability of the device with a prescription will help prevent overdose deaths in emergency situations.

Opioid analgesics are a family of opiate-based drugs commonly used in prescription painkillers. They are derived from the same source as heroin and several other illegal narcotics. Common opioids include codeine, hydrocodone, morphine, and oxycodone. Opioids can be very addictive, so they are tightly controlled by the government. According to the Centers for Disease Control and Prevention (CDC), 16,651 people died of drug overdoses involving opioids in 2010, the most recent year for which statistics are available. This number accounts for about seventy-five percent of all drug overdose deaths that year. Many overdoses involve legally-obtained prescription painkillers. The total number presumably includes intentional and accidental overdoses, as well as dosage errors by a physician or pharmacist.

Evzio, as approved by the FDA, is a handheld device that injects naloxone hydrochloride, an “opioid antagonist” that is a common treatment for opioid overdose. Emergency responders often carry naloxone-containing products for use with suspected overdose victims. Since Evzio is only available with a prescription, it must be obtained in advance of any emergency situation. It is recommended for family members and caregivers of people using opioid painkillers in case of overdose. The device provides verbal instructions for use once it is turned on. A single dose of naloxone, according to the FDA, does not last as long as a typical opioid, so it cautions that the device is not a substitute for medical attention. What the device can do is delay further injury or death due to an overdose until medical attention is available.

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As previously discussed on this blog, one of the most common errors made by prescribing doctors, or in those who input values, is accidentally increasing the dosage, such as in the entering of “10.0 mg,” when the person should have input “1.0 mg.” Even though the error is only a matter of a decimal, it could kill or severely injure a patient. laptop%20w%20hands.jpg

Medication errors such as these occur frequently, at an estimated one million incidents each year, contributing to 7,000 deaths.

According to recent research, the best known way for hospitals to protect patients from errors is by adopting technology called computerized physician order entry (CPOE). The way these systems work, is that when the person who is entering the prescription into the system enters the values, they are checked against the patient’s records, allergies, etc. This information is then cross referenced for safety and other measures before being sent to the pharmacy. In the opening hypothetical, a properly performing system would alert the physician to the misplaced decimal in the order. Some of the best systems may have actually prevented the order from being written in the first place.

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With the advent of new electronic means of managing patient health records, there are now additional ways in which prescription errors can take place.

For example, PCEHR, the Personally Controlled eHealth Record System, was adopted in June 2012 in Australia. facts%20list.jpgIt is a health information database designed for use by patients, and according to the National E-Health Transition Authority’s website, “is currently distributed across a wide range of locations including their general practices, hospitals, imaging centres, specialists, and allied health practices.” In essence, the PCEHR is somewhat like an all encompassing electronic health record of a patient. The aim of the program is to make the healthcare system more streamlined and efficient, allowing patients to effectively “share” it with relevant care providers.

A recent article entitled “Pharmacy Error Probable Cause of PCEHR Problem,” which was published appropriately enough in Australia’s eHealth Magazine, details how one woman’s PCEHR somehow received not one but two incorrect prescriptions.

The author reported that she discovered that two prescriptions had been added to her PCEHR. The prescriptions were for drugs that had never been prescribed to her, and were for medical conditions that she did not have.

The drugs were not only written into her record, but apparently were also dispensed by her local pharmacy, even though a notice regarding a consultation at the time they were allegedly dispensed was lacking. The relevant government agency encouraged the woman to inquire with the pharmacy regarding the error, and in doing so the pharmacy cancelled the prescriptions on her patient file. Within a day of the pharmacy’s correction, the woman’s PCEHR was also updated. However, the government told the woman that the same prescription had actually been dispensed on an additional occasion, from a different pharmacy.

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In an ironic finding, considering a recent article indicated that ordering drugs via a computer order entry system actually decreased the risk for error, a new study analyzed by Pharmacy Practice News concluded that Electronic Health Records (EHRs) may lead to an increase in medication and other treatment errors. files.jpg

The study found that for various reasons, electronic health records may lead to more drug mistakes rather than prevent them.

The study examined the Pennsylvania Patient Safety Reporting System (PA-PSRS) database, and by utilizing specific search terms, found over 8,000 relevant reports during an eight year period. After sifting through the results, a little over 3,000 were found to have some sort of error.

Among these, the results were as follows:

  • 89% of the records were labeled “event, no harm,” meaning that the error did not result in an adverse effect on the patient
  • 10% were labeled as constituting “unsafe conditions,” which also did not result in patient harm
  • 0.48% involved some sort of temporary harm to the patient.

Of these 0.48%, the harm was caused by:

  • entering incorrect medication data
  • administration of incorrect medicine
  • ignoring a documented drug allergy
  • failing to enter lab test results
  • failure to document

One of the incidents in particular involved a failure to document an allergy to penicillin, which resulted in a significant harm to the patient.

Of all of the resultant error, 81% of them dealt with medication errors, including incorrect medication, incorrect dosage, timing, patient or route. Of the remaining errors, around 13% were regarding issues with complications of procedures, tests, or other treatments.

A common recurring problem uncovered by the researchers was the entering of data in the wrongplace, or inputting incorrect information, such as the wrong physician name.

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Dpk-meningitis-exserohilum2.jpgA bill introduced late in the most recent session of the U.S. Congress would have enhanced federal regulation of compounding pharmacies. The bill never made it out of its committee, but the representative who introduced it says he plans to try again in the new session. At least one state governor has also proposed a state-level bill, and a nationwide organization is conducting its own pharmacy inspections. The nationwide outbreak of fungal meningitis in late 2012, traced to a compounding pharmacy in Massachusetts, was a major factor in bringing about these actions.

Congressman Edward J. Markie, the Democratic representative for Massachusetts’ Fifth District, introduced H.R. 6584, The Verifying Authority and Legality in Drug (VALID) Compounding Act on November 2, 2012, not long before the end of the Congressional session and only a few days before the 2012 Presidential Election. It gained eight cosponsors, and was referred to the House Subcommittee on Health, where it remained, and died, at the end of the 112th Congressional Session. Given the turbulent political atmosphere in Washington DC at the time, it is perhaps not surprising that the bill gained little support or attention. Markey has stated that he intends to reintroduce the bill in the 113th Congress.

The VALID Compounding Act would give the U.S. Food and Drug Administration (FDA) authority over large compounding pharmacies, particularly those that act as drug manufacturers. Smaller “traditional” compounding pharmacies would be exempt from FDA regulation, provided that only licensed pharmacists or physicians personally compound drugs for individual patients with valid prescriptions, the pharmacy uses best manufacturing practices and approved ingredients, and it does not copy commercial drugs. Compounding pharmacies could request waivers of the three restrictions from the FDA in cases of drug shortages or if it is deemed necessary for public health. The law would also create a public list of drugs that should not be compounded, and would require labeling of compounded drugs to indicate that the FDA has not tested or approved the drug.

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