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The Baxa Repeater Pump is a pretty cool piece of pharmacy technology. The device automates many of the repetitive processes used in filling oral syringes, oral dosage cups, syringes used for injection and reconstituting medications used to mix intravenous medications in the acute care setting. I remember working in a pediatric facility and watching the technicians fill thousands of oral syringes with liquid acetaminophen and ibuprofen for use in automated dispensing cabinets throughout the hospital. With the use of the Syringe Filling Fixture, and the automated pump setting on the Repeater Pump, the technicians could fill a phenomenal number of syringes in a very short period of time. Other times the technicians used the foot pedal on the Repeater Pump in order to control the rate at which the process moved; art in motion. Either way it was a bummer when they were finished as I had to check all those syringes. Regardless, the pump was a valuable piece of equipment when repetitive fluid transfer was required.

Information on the Baxa website is lacking to be sure, but they do list the following:

One Nucleus: “The technique will allow faster identification and resolution of any manufacturing quality problems but will also prove invaluable as an anti-counterfeit measure because the specific coding and validation systems are almost impossible to copy.

Currently most components within diagnostic kits, medical devices and other healthcare products and equipment are ‘stamped’ with a lot code at the point of manufacture. However, these codes are of limited use for quality improvement unless products are produced in very small batches. As a result, regulatory bodies across the world are now putting manufacturers under increasing pressure to invest in much more sophisticated traceability systems, while manufacturers are looking for effective ways to prevent the growing problem of counterfeiting of pharmaceuticals and other healthcare products.

The breakthrough approaches being developed by Innomech will enable manufacturers to mark products with a code that is either unique to the item or shared by only a small number of items produced together.

As pharmacists begin to move out of the physical pharmacy to the patient bedside I think it will become important not to forget the value of a pharmacist that is well versed in how to handle the operational side of pharmacy. Don’t get me wrong, I think pharmacists should be used more for therapeutics than for the role of physically dispensing medications. However, consider a practice model for pharmacy where technicians are more involved with the day to day operations and automation plays a bigger role in the dispensing process. In this instance a pharmacist will be needed for technician oversight as well as to control the workflow of the pharmacy. In addition that pharmacist will need to intimate working knowledge of the automation and technology used in the pharmacy space. I don’t believe that a pharmacist needs to see every single item dispensed from the pharmacy, but I do think global oversight is necessary. There are opportunities for positive interventions in all aspects of acute care pharmacy practice.

I began my career as a “operational specialist”. The hospital where I was employed used a hybrid model of satellites and centralized dispensing. They needed stability in the dispensing area secondary to the pharmacist shortage. The pharmacy manager came to me and offered me a unique opportunity to handle the workflow in the main pharmacy from an operational standpoint. The hours were’t great, working Monday through Friday from 1:30pm until midnight, but it gave me a chance to try something new. I spent about a year in this role and found great value in the lessons learned through trying variations on the age old themes of cart fills, ADC replenishment, IV batches, etc. It was worth it.

While at Innovations a couple of weeks back I stumbled across the Imprivata booth at the vendor expo. There were quite a few people gathered around the booth so I obliged my curiosity and squeezed in among the crowd. The Imprivata representatives were giving a demonstration of the company’s OneSign 4.5 application with Walk-Away technology. There must be something compelling about the Imprivata line of products as I found myself blogging about their OneSign Platform about this time last year.

The Walk-Away technology was impressive. As long as a user was standing in front of the computer camera they remained logged in. However, as soon as the user turned to walk away they were immediately logged out of their session. This is a significant step forward in managing those unattended workstations that one often finds throughout the hospital.

From the Imprivata website: “OneSign Secure Walk-Away closes a critical security gap in the protection of confidential information assets by automating the process of securing the desktop when a user ‘walks away’. Once a user has securely authenticated to the desktop using OneSign Authentication Management, OneSign Secure Walk-Away uses a combination of computer vision, active presence detection, and user tracking technologies to identify an authenticated user and automatically lock the desktop upon their departure.”

I’ve been on a mission, however small it may be, to get pharmacy technicians more involved in the operational aspect of acute care pharmacy. And by more involved I mean using a tech-check-tech model to free pharmacists up for more patient related clinical activities. I’ve posted my thoughts on the use of tech-check-tech before.

The reason for rehashing the issue is due to a conversation I had with a colleague last week. This particular colleague and I were having a light hearted discussion over the possibility of using a tech-check-tech model with automated packagers like those I described in a post earlier this week.

The 2010 Lawbook For Pharmacy, which is available at the California Board of Pharmacy website, has provisions for the use of tech-check-tech in certain situations. I’m referring to Title 16, Division 17, Article 11, Section 1793.8 –Technicians in Hospitals with Clinical Pharmacy Programs, which reads:

I came across this post at Mobile Health Computing, one of the many blogs of Dr. Joseph Kim.

Is this the future of mobile computing?

Here’s a great photo of an Apple iPad on a stand with a keyboard on the desk. Is this the future of mobile computing? Will we all end up using thin slate tablet computers that are held up on stands? While we’re sitting on a desk, we may use the keyboard. When it’s time to go, we grab the slate and we run off. No keyboard needed since we’re probably going to be computing on-the-go.

The image from Dr. Kim’s post reminded me a similar setup I’ve seen in a pharmacy before. The image to the right is a J3400 tablet PC attached to the Motion FlexDock. The FlexDock offers support for an external monitor, RJ45 nectwork connectivity and multiple USB ports for keyboard, mouse and printer. In addition the FlexDock includes a charging bay with room for an additional battery.

Would it surprise you to learn that the setup to the right was introduced more than a year ago (early 2009), and that the J3400 is an “older” model tablet PC that was recently replaced by the J3500? I find that interesting.

August 12, 2010 issue of the ISMO Medication Safety Alert the issue of : “We have received a number of reports about the labeling of Xactdose unit dose liquid containers from VistaPharm, Inc., of Birmingham, AL. The company recently changed the way the drug concentrations are expressed on their labels. An example is phenytoin oral suspension which went from emphasizing 100 mg/4 mL to listing 125 mg/5 mL. The company rightly notes that the 125 mg/5 mL container delivers 100 mg or 4 mL (due to the heavy liquid consistency of phenytoin suspension), but the message doesn’t necessarily translate to nurses who are confused by the new label and need to give an exact dose. The good news is, we learned last week that VistaPharm is returning to the old style label. That will no doubt lead to less confusion, but nurses should also know not to rinse the residual suspension from the cup. Doing so would approximate as much as a 25% overdose. The company said they expect to release products with revised labeling by the end of the month.”

This ISMP Alert was perfectly timed because we had confusion over this labeling just a couple of weeks ago. I grabbed one of each label type out of the carousel and snapped a couple of pictures. See below. The top image is of the original labeling, the middle image is the new labeling and the bottom image is the two sitting side by side for comparison.

I’ve mentioned Panasonic Toughbooks on this website before. I’m a real fan of the Toughbook C1 tablet PC with its multi-touch digitizer, 10 hour battery life, spill-resistant keyboard and tough magnesium alloy exterior. It’s definitely on my short list of most desired devices.

It turns out that Toughbooks are more than just cool technology, they may actually save healthcare a little money when used the right way. NHS Kirkless, a primary care trust in the UK estimates that they are saving more than $900,000 per year by deploying 600 Toughbooks to their care providers in the field.

Smart Healthcare.com:

Remote working in patient care, with staff ‘hot-desking’ using mobile broadband-enabled laptops, is a proven cost-saver for the NHS. But the idea has been met with caution by some trusts owing to the limitations of 3G mobile reception.

However, one primary care trust, NHS Kirklees, has embraced the technology by deploying around 600 Panasonic Toughbooks, supplied and serviced by BT Health. The staff are, in the words of Robert Flack, managing director of Kirklees Community Healthcare Services (CHS), “loving it”.

Flack’s NHS organisation is the provider arm of NHS Kirklees, which employs more than 1,200 staff to meet the healthcare needs of more than 400,000 people across Dewsbury, Batley, Spenborough, and central and southern Huddersfield.

I came across an interesting article recently in the International Journal of Biomedical Engineering and Technology¹. The article discusses the difficulties in designing an EMR system capable of providing optimal access to data elements while remaining efficient and user friendly.  It was a good look at the current state of healthcare data exchange.

Abstract:

This paper discusses how to share medical information between heterogeneous applications via web services. Our design theory is based on a real-options framework, performance analysis and experience building iRevive, a working web-services-enabled pre-hospital documentation application. The trade-offs between efficiency and flexibility are examined in the context of exchanging information based on emerging standards in the healthcare world. These trade-offs are quantified using a real-options approach. We illustrate the importance of uncertainty in deciding the architecture enabling an application to access medical information from Electronic Medical Records (EMRs).

The article goes into quite a bit of detail in describing the trade-offs between getting access to all the information necessary to perform your job and the need for usability and speed in a data driven system. The article centered on building an integrated hospital EMR system designed to collect data via web services instead of the “every day” desktop applications typically seen in a hospital.

Some of the key points from the article include:

Recently I’ve been in bit of a blogging slump. The world of technology suddenly appears a little less exciting. In fact, I find myself thinking of current technology as boring. I read lots of blog posts and articles that refer to new technologies as “revolutionary”, but I haven’t seen much revolutionary technology lately. In fact, most of the new technology is simply an iteration of the same theme; or worse, recycling of an old theme.

Consumer technology is clearly ahead of healthcare with the exception of scanning devices like MRIs, which are pretty cool when you stop to think about what they do. However, some of the most recently vaunted consumer technologies are devices aimed at information consumption like the iPad or devices designed to access data and social media while on the go, i.e. the new crop of smartphones. It’s not really new technology per se, but rather a new application of already available technology.

Because I am a member of the American Society of Health-System Pharmacists (AHSP) I have access to the ASHP Pharmacy Informatics and Technology section listserv. Listservs are a great source of information, and as the name implies, this one is particularly good for getting information on all things related to pharmacy automation, technology and informatics.

A recent post on the informatics listserv caught my attention. The thread was started by a pharmacist asking what skills are necessary for a career in pharmacy informatics. Several pharmacists have chimed in with some great advice, while others have given what I consider to be less than helpful advice. Needless to say the responses have been all over the board as there is no universally accepted definition of what an informatics pharmacists does. Some pharmacists have recommended gaining skill in specific areas, i.e. reporting, HL7 ,etc, while others have taken a broad approach by offering advice on gaining experience in operations, project management, leadership and workflow concept and design.

There’s an interesting article at InformationWeek about healthcare and the cloud. The article talks a little bit about the concerns surrounding security in the cloud and what I believe is an undeserved fear of using cloud based services and storage for healthcare information.

In the article a pediatrician that is also director of clinical informatics for Atrius Health is quoted as saying “At the moment I’m not convinced that there’s a secure enough place in the cloud or that the functionality exists for us to do everything that we need to do in the cloud. The cloud allows for a tremendous amount of interconnectivity between computers because it’s using data storage that’s free amongst different networks and I wouldn’t want healthcare information being scattered in a way that I couldn’t protect it appropriately.” I’m not sure I understand the perceived insecurity of the cloud as the existing infrastructure for storing patient information in healthcare is, by design, insecure.

The June 17, 2010 issue of ISMP Medication Safety Alert I received has an interesting article on the unintended negative consequences of the Centers for Medicare & Medicaid Services (CMS) regulation requiring medications to be administered within 30 minutes of their scheduled dosing time. I’m sure that the CMS 30-minute rule was created with good intentions in mind, but in reality it creates a lot of anxiety and bad habits. According to the ISMP article, the CMS 30-minute rule “may be causing unintended consequences that adversely affect medication safety. While following the 30-minute rule may be important to hospitals, many nurses find it difficult to administer medications to all their assigned patients within the 30-minute timeframe. This sometimes causes nurses to drift into … unsafe work habits.” Those unsafe work habits include removing meds from automated dispensing cabinets (ADC) for multiple patients at once, removing meds ahead of time, falsifying documentation to meet the 30-minute rule and preparing doses ahead of time; all dangerous practices.

The problem is more widespread than most realize and often flies under the radar. I knew about the issues, but wasn’t prepared to deal with them until we went live with our bar-code medication administration (BCMA) system. A side effect of the BCMA system is that it tends to catch things like late and/or early medication administration. That means no more mythical med passes with all medications administered at exactly the same time.

Last week I posted about some bar-coding troubles we were having. One of the comments regarding the information in the post was left by a pharmacist named Max Peoples. Max offered up some great information and mentioned a piece of software called NDC Translator from RxScan.

From Max’s comment: “One answer to the medication NDC # barcode scanning problem is to use the software called NDC Translator(TM) with your barcode scanners. Information at http://www.rxscan.com/rx.shtml

It intercepts the raw data coming from the barcode scanner, evaluates it’s content and if it contains the 10 digit NDC # (required to be there by law in a medication barcode) it converts the raw data into the 11 digit NDC # format and then sends the 11 digit NDC over to the application you are scanning into, in this case Jerry’s barcode labeling software.”

I’ve read about NDC Translator before and dismissed it because I couldn’t find enough information on the company’s website. However, secondary to last week’s mishap I’ve decided to re-evaluate my position and give NDC Translator another look. The concept is simple and straight forward, but what the software does behind the scene is not. The upside is tremendous as it has the potential to prevent mix-ups like those described in my previous blog post.

I’m sure you’ve heard people say “just Google it”. Not only have I heard the phrase, but I’ve used it myself. But how do search engines like Google and Bing work for health related information? Out of simple curiosity I spent a few minutes with Google and Bing to find out.

Drug searches
A search for losartan using Google resulted in a link to the NIH’s United States Pharmacopeia as the first item listed. The site provides consumers with basic drug information from AHFS Consumer Medication Information. Not bad.

Bing produced similar results, albeit from a different source. Bing uses a tabbed user interface to provide consumers with access to drug information from Gold Standard and Wikipedia, of which I am not a proponent. Not bad either.

Disease states
A search for MRSA in Google resulted in a link to Google Health where I found basic information provided by A.D.A.M. The second item on the Google results page was a link to a page at the Mayo Clinic on MRSA.

The MRSA search in Bing resulted in the same tabbed interface that I saw with the drug search. The tabbed interface gave easy access to information on MRSA through Bing Health, provided by Healthwise , and also Wikepedia. The information at Bing Health was just as generic as the information found at Google Health. The second item on the Bing results page was the same as Google, i.e. the Mayo Clinic MRSA information page.