medsafetyonline

A forum for caregivers and pharmacy professionals concerned with patient and provider safety.

Chuck DiTrapano RPh

Reflections on the Future of Infusion Safety

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In life, you don’t often get a chance to be a part of something at its inception. Those of us who attended the first NICA meeting in Austin were provided just such an opportunity. For the very first conference put on by NICA, it was flawless. The breakout sessions were informative and subject matter was on point. The food was even good! Credit goes to NICA leadership: Brian, Morgan, Amy and the rest of the team.

For the RxTOOLKIT team, the best part of the meeting was the people: the attendees, the speakers, and the other exhibitors. We were fortunate to be part of many lively and productive discussions about issues facing the infusion market today: medication safety, operational costs, quality of care, clinical excellence, patient satisfaction, and staff training.

What became clear to us was that for providers, the patient and their experience was one of the most important goals of care. To accomplish this the focus was on staff competency, appropriate technology, and outcome measurement. This included using outcome data as a tool to rewrite and improve the very goals of care.

Another big highlight of the meeting was the release of the NICA Minimum Standards for Outpatient Infusion. This important document is the first step in developing the process and consistency necessary for the safe preparation and administration of sterile parenteral products in an outpatient infusion environment.

We are also thrilled to report that RxTOOLKIT already has tools available that help providers meet or exceed a number of the recommendations made by the NICA Minimum Standards! We are excited to be an integral part of helping this vital industry in providing a safer, more convenient, and cost-effective channel for infusion therapy in patients with chronic illness.

The relationships that we establish in life can often help shape our future successes. With an open dialogue and through the exchange of ideas we can lift each other up, improve the quality of care, and make it safer for both patients and caregivers.

For more information please contact us or visit: ivsafety.rxtoolkit.com

Increasing Confidence with Best Practices for Infusion Therapy

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There have been so many improvements in the outpatient infusion market in recent years. The good news is that patients can now achieve a higher quality of life even when they are afflicted with a lifetime chronic condition through treatments utilizing periodic injections or infusions. If you place yourself in any patient’s shoes, what would be most important to you? Besides things like clean, comfortable surroundings, or a location close to home, my top two would be:

  1. Confidence in those rendering care.
  2. Confidence in my treatment and its safe delivery.

RxWORKFLOW for IV Safety™ was created to help infusion centers provide these important benefits to their patients.

RxWORKFLOW for IV Safety™ provides a collection of user-friendly drug specific monographs with interactive reference, tools, and training designed specifically for clinicians who prepare and administer IV medications.

In every RxWORKFLOW for IV Safety™, the interactive reference (drug information) is organized in a simplified, concise format, giving any nurse the ability to find what they are looking for, within just a click or two. We include only the most important information that is commonly needed and format it for easy access.

There is a lot of information available out there, often it can feel like you are “drinking from a fire hose”, especially when it comes to drug information. If you aren’t providing concise up-to-date supporting information for your staff, how can you know where they are getting it? Clinicians often need to make critical decisions very quickly. Easy access to accurate reference can improve efficiency and staff confidence. It also eliminates guesswork based on potentially incorrect or out-of-date information.

We have also included tools in every RxWORKFLOW for IV Safety™ monograph including RxQuickCALC™, RxCALC™, and RxDoseCHECK™ to provide consistency and minimize the potential for errors in drug preparation and administration. The tools provide step-by-step instructions and are always what clinicians need for that specific drug. They establish a standardized process for preparation and administration, getting every nurse on the same page, and helping to instill best practices.

Not having support tools or an established process in place for preparation and administration tends to make clinicians inefficient and prone to error, especially when they haven’t performed a particular task in some time. It’s easy to forget or get mixed up—How does this go? Is there a filter on this? Can I use D5W as a diluent? Providing support tools can minimize mistakes and set the standard of practice for ensuring positive patient outcomes.

Also included in every RxWORKFLOW for IV Safety™, Integrated Competency Checks, quick on the spot quizzes, allow clinicians to test their understanding of the key elements of the drug information. We designed the quizzes to be learning tools by providing immediate and thorough feedback to the clinician.

With knowledge comes a sense of confidence that is palpable. For a patient, being treated by a confident caregiver who they trust can provide:

  • Increased confidence in their treatment
  • Increased confidence in the staff and organization
  • Satisfaction that they chose their caregivers correctly
  • Reduction in potential for treatment failures
  • Lowered potential for side effects

Many of the highest risk medications are delivered by IV infusion. In fact, 61 percent of the most serious and life-threatening potential adverse drug events are IV drug related.1 IV drug administration often results in the most serious outcomes of medication errors.2

Many patient safety and professional organizations now strongly recommend IV preparation and administration process standardization especially for vulnerable populations or high-risk drugs. Standardization and training become even more critical when you combine multiple drugs, staff members, and/or clinic locations.

In the Chronic Care Infusion setting, it is especially important to establish consistency and make sure the dose is appropriate for the patient weight or age range. Often, the person preparing or administering a medication may have limited experience or the drug may have complex requirements, be high-risk or expensive.

RxWORKFLOW for IV Safety™ gives every clinician the information and ability to safely prepare and administer any drug in our library with confidence.

RxWORKFLOW for IV Safety™ makes it easy to provide drug-specific support ­for your staff including standardized reference, tools, and training. By doing so, your practice can reap the many benefits: minimize the risk for errors, increase patient and caregiver safety, provide cost savings, establish best practices, and of course, increase both patient and caregiver confidence.

For more information about this awesome tool, check out this short video, contact us, or visit RxTOOLKIT.com.

[1–2]: http://www.hqinstitute.org/highriskmed (sdpsc_safe_administration_of_high-risk_iv_medication.pdf):[1] Communication with D.W. Bates, M.D., M.Sc. of Brigham & Women’s Hospital in Boston, October, 2001. [2] Hicks, RW, Cousins, DD, Williams, RL. (2003). Summary of Information Submitted to MEDMARX® in the Year 2002. The Quest for Quality. Rockville, MD: USP Center for the Advancement of Patient Safety.

Ensuring Drug Specific Competency for Infusion Center Clinicians

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As with any occupation, there’s a lot to know in order to become a competent and proficient professional. Healthcare is no different. Based on your specific discipline, be it pharmacy, nursing, or physician, there are skills and tasks that are essential to the successful completion of your responsibilities.

For infusion center clinicians, the most essential information is undoubtedly in-depth drug knowledge. That includes knowledge of: drug preparation, drug administration, patient response(s) to drugs, and what to do in the event of an adverse patient reaction. In an article published in the British Journal of Clinical Pharmacology[1], Jeffrey K. Aronson explains the following (as it relates to medication errors):

Errors are first broken down into two separate categories:

1. Mistakes
2. Skill-based errors

Mistakes are then divided into two categories:

1. Knowledge based errors
2. Rule-based errors

Skill-based errors are divided into two categories as well:

1. Action based errors (slips)
2. Memory based errors (lapses)

What does this mean to the infusion center clinician?

To prevent both rule-based and action-based errors, we recommend utilizing RxTOOLKIT’s RxWORKFLOW for IV Safety™. These user-friendly drug specific monographs provide interactive reference, tools, and training, right where every clinician really needs them, at the point of care. Within each drug specific monograph, the “rules” for drug preparation and administration are presented in an easy to follow format that guides the clinician through a safe and consistent process.

RxWORKFLOW for IV Safety also helps to prevent “slips” by providing drug specific on-the-spot tools that assist in preparation or administration (RxQuickCALC™, RxCALC™, and RxDoseCHECK™). These tools are always what you need for that specific drug and include step-by-step instructions, tapering tables, and automated calculations helping clinicians to avoid an action based error.

So how do you address Knowledge and Memory Based Errors?

Let’s start with Knowledge Based Errors.

RxTOOLKIT provides a Drug Specific Competency Tracking Program in our popular LMS platform, RxTOOLKIT eLEARNING. Drug Specific Competency Tracking is an ongoing program that was built specifically for training, certification, and tracking of drug knowledge. The program provides drug specific courses with interactive assignments and competency exams. Clinicians can retake the courses periodically whenever their certification expires (as determined by your organization). This program enables clinicians (and their managers) to verify that their drug knowledge is complete and up to date.

To help with Memory Based Errors, which the author describes as “lapses”, we return to the point of care, right inside every RxWORKFLOW for IV Safety monograph, where clinicians find an Integrated Competency Check. Integrated Competency Checks—quick drug specific pop-up quizzes, including instant feedback, help to ensure your staff is familiar with both a drug and related dosing parameters. The quizzes act as a quick refresher, helping to confirm comprehension of the “rules” and increasing caregiver confidence.

RxTOOLKIT’s goal is to provide the infusion center clinician a single source of standardized reference, tools, and training. We can help any center to establish standardization in practice and staff training and ensure their positive patient outcomes.

For more information about these two awesome tools, RxWORKFLOW for IV Safety and Drug Specific Competency Tracking, check out these short videos, contact us, or visit RxTOOLKIT.com.

 

 

[1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2723196/pdf/bcp0067-0599.pdf

Taking Control of Your Internal Reference Library

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We’ve all seen this; a healthcare worker in a white coat, pockets stuffed with papers. In hand, they have a notebook, handheld calculator, and a variety of dog-eared papers.

Early in my career, I decided to take a clinical supervisory position after serving 15+ years as a traveling executive for a healthcare company. Though I had been a licensed pharmacist for 25+ years, I had not “practiced pharmacy” in a long time. One of my colleagues at the time jokingly referred to me as “clinically dead”.

Pharmacy practice had seen many changes in my 15-year “absence”. When I left, hospital pharmacists were consigned to one room together, typically in the basement somewhere. But now, I was observing a highly diversified and far more clinically evolved practice. Pharmacists were out on the floor with nurses and the dispensing function was being integrated more fully with direct patient care.

My biggest concern was that I had no idea what reference information was in the pockets of all those white coats for which I had the responsibility to supervise. I felt that I had no control over the information my staff was using in the clinical decision making process.

I asked each of my staff to give me a copy of what there where using as a reference and/or tool in their decision-making process. Once they were gathered, we complied those papers and put them on the web for ease of access. We added search terms to make it even easier to find the information and RxDOCUMENT™ was born. Actually, it was the birth of RxTOOLKIT® itself, as that was our very first app.

RxDOCUMENT™ provided an easy to access standardized internal reference library and eventually grew to hold slide presentations, in-service materials, policies, procedures, and best practice recommendations.

RxDOCUMENT™ was our first application and is still one of our most popular!

Of course, now days, your staff could be using a digital notepad full of links. But whatever method they use, what really matters is taking control, and getting everyone on the same page. RxDOCUMENT™ can help you to establish your standardized reference library and provide a strong foundation for your staff’s clinical decision-making process.

For more information about RxDOCUMENT™ please contact us or visit RxTOOLKIT.com.

We Support Pennsylvania House Bill 770!

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“An ounce of prevention is worth a pound of cure.”

B. Franklin

On April 9, 2019 my colleagues and I from the Pennsylvania Society of Health System Pharmacists (PSHP) will be attending a meeting with Pennsylvania State Representative Tony DeLuca. Representative DeLuca, along with 12 other co-sponsors, have sponsored House Bill 770 into the General Assembly of Pennsylvania.

This bill, when passed and signed into legislation, will amend the Pharmacy Act to “further provide for definitions; and providing for pharmacy technician and pharmacy technician registration, qualifications and supervision”. Pennsylvania is currently one of only four states that do not provide Board of Pharmacy oversight of pharmacy technicians through registration or licensure.

In 2006, Ohio was one of those states without any oversight of pharmacy technicians. In February of that year, a tragic error committed by a pharmacy technician and not caught by a pharmacist resulted in the death of 2‑year-old Emily Jerry. Once Emily’s dad, Chris, understood the cause of Emily’s death, he took it upon himself to change the law in Ohio. Emily’s Law was passed in December 2008 and went into effect on April 8, 2009.

As with any change in law and/or regulations, there are voices on both sides of the argument. House Bill 770 is no exception. On one hand, it seems so logical. Why would you not want to regulate and demand standards of practice for individuals who prepare medications? On the other hand, there are economic issues that come with regulations and competency.

The answer, in my opinion lies with Ben Franklin. Prevention in healthcare typically leads to a better quality of life and can at the same time provide cost savings for patients and providers alike. It’s why we do things like vaccinate and perform cancer screenings. There are so many benefits to pharmacy technician training, but the most important one is that trained, competent, and reliable techs can drastically reduce any facility’s overall medication error rate.

When Pennsylvania adopts House Bill 770, my home state will take a step forward to prevent a tragedy like Emily’s from ever happening again. This makes Emily’s short time on this earth all the more meaningful and it is absolutely worth the continued fight!

Pennsylvania residents please call or write your representatives and ask them to support this bill!

About the bill:

Who is my Pennsylvania Legislator?:

 

Photo Credit: Governor Tom Wolf, The Pennsylvania State Capitol in Fall, November 4, 2015, Harrisburg, PA used under Attribution 2.0 Generic (CC BY 2.0) source: https://flic.kr/p/AH98zR