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Pharmacy Technology

Taking Control of Your Internal Reference Library

May 7, 2019 by Chuck DiTrapano RPh Leave a Comment

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.

Filed Under: Medication Safety, Personal Stories, Pharmacy Technology Tagged With: Communication, medication safety, organization, patient and provider safety, pharmacy technology, RxTOOLKIT

Check out the new RxTOOLKIT.com!

March 27, 2019 by admin Leave a Comment

The new RxTOOLKIT.com

Our marketing team has been hard at work updating the site to showcase our latest apps and services

RxTOOLKIT® is proud to announce the launch of our new marketing website which coincides with our expanding role as a medication safety leader.

The primary objectives of our site development effort were focused on aesthetics, simplifying content, and increasing the visibility of our applications. Our goal with this update is to provide our visitors an easier way to learn about RxTOOLKIT’s services and solutions. Explore the site to learn more about our full spectrum of available applications: RxTOOLKIT.com.

We would also like to thank the marketing staff at RxTOOLKIT who invested their time and energy to make this update happen.

For questions, suggestions, feedback or comments, please contact us.

Filed Under: Medication Safety, Pharmacy Technology

RxTOOLKIT® Announces Partnership with the Patient Safety Movement Foundation

April 19, 2018 by admin Leave a Comment

RxTOOLKIT® is pleased to announce its support of the Patient Safety Movement Foundation (PSMF) and its mission to eliminate preventable deaths by 2020 (0X2020™).

The Patient Safety Movement Foundation believes that reaching ZERO preventable deaths in hospitals by 2020 is not only the right goal, but also an attainable one with the right people, ideas, and technology. Many pieces of the puzzle already exist. Solving this problem is a matter of connecting the dots.

We recently became a committed partner of the PSMF and have signed an official PSMF Commitment to Action. You can view RxTOOLKIT® and other committed partners on the PSMF website by clicking here. Once on the page, click on any logo to view each committed partner’s Commitment to Action.

We are also thrilled that PSMF has decided to feature Pharmacy Technicians University on their resource page!

According to PSMF, “Committed Partners are a diverse group of professional societies, associations and healthcare-related organizations who have joined our movement to help address the large-scale problem we face worldwide; preventable medical errors within hospitals. We must improve systems to make healthcare safer, and the primary way to improve patient safety is through mutual learning. We encourage all individuals within the healthcare sector to join as we shift stories of preventable death into stories of success and actionable solutions to reduce the occurrence of harm.”

“We thrive on the opportunity to generate unique ideas and facilitate quality conversations that lead to purposeful action. Our partners provide us with the opportunity to access a wider range of resources and expertise across all sectors, and in turn, partners reap the benefits of joining a collaborative group of aligned, passionate, and results-driven individuals.”

We couldn’t agree more and are proud to be a part of the PSMF’s commitment to action! We fully support their ultimate goal of reducing the number of preventable deaths in hospitals to ZERO by 2020!

Please feel free to contact us if you would like more information about RxTOOLKIT’s Commitment to Action or Pharmacy Technicians University.

Filed Under: Medication Safety, Pharmacy Technology Tagged With: awareness, medication safety, patient and provider safety, RxTOOLKIT

The Evolution of Technology and Human Interaction

October 23, 2015 by Chuck DiTrapano RPh Leave a Comment

I recently had a chance to read the article The Overdose: Harm in a Wired Hospital. If you have the time, it’s worth reading. This article brings up a number of important issues. I wanted to share my thoughts about those issues and the evolution of technology and human interaction in pharmacy.

As technology evolves, the role of the healthcare professional is changing. I am not entirely convinced that all of the changes are for the better. In fact, I believe the interface between humans, technology, and competency is potentially heading in the wrong direction! I base my observation on the following practice tenants:

1.   Assume it’s wrong.

2.   Who’s making the decision?

3.   Make this screen go away!

4.   Can I do this with my eyes closed?

5.   It’s too big to fail?

 

Assume it’s wrong.

As a practicing pharmacist, one of my responsibilities is to enter physicians’ orders into the pharmacy electronic system. As I do this, I ask myself several questions with each order: What was the physician’s intent? Is the drug / dose appropriate? Are there clinical issues with this drug on the patient’s medication profile? Only when I can answer ALL of these questions will I enter the order. By doing so, I have taken ownership of that order.

It’s easy to become complacent and assume that my purpose is to simply enter the order. But there is a big difference between just entering an order and taking ownership of it. I have a colleague who, when training new pharmacists, tells them to always assume the order is incorrect until it can be proven otherwise.

Many times the pharmacist’s approach is to default to the physician’s judgment. This unspoken chain of command was certainly a factor in The Overdose. The author points out, “As is so often the case with medical mistakes, the human inclination to say, “It must be right” can be powerful, especially for someone so low in the organizational hierarchy, for whom a decision to stop the line feels risky.” We may not be naturally inclined to question the physician’s orders, but sometimes it is imperative that we do so.

Additionally, human instinct is generally to look at something in a digital format and assume it’s correct. As the author in The Overdose points out, “humans have a bias toward trusting the computers, often more than they trust other humans, including themselves.” It takes an extra step to take a step back, ask questions, and actually take ownership of the order.

 

Who’s making the decision?

Where are we in healthcare IT today? We need an interface. We need to minimize keystrokes. It needs to be in the cloud. We want computer systems to talk to one another. We want to minimize the human intervention because human intervention leads to errors.

In theory, I agree with all of these statements. But I believe we must ask, “When do we need human intervention?” The fatal error that occurred in The Overdose points directly to this issue. This error was not due to a knowledge deficit in either physician or pharmacist. Both knew what was appropriate for this patient, but they missed the mark. I think the key factor was humans taking a backseat and allowing the IT system to make the decision. Are we comfortable with that?

In an effort to eliminate interface issues, we are gradually pulling healthcare professionals out of the decision making process. What role does it leave for us humans? I am certainly not against technology; in fact I’m all for it! But I am concerned that we are going too far, too fast. Technology should enhance and guide our decisions, provide answers, and make our jobs easier. It should help to educate us and make us better at our jobs. It should not make decisions in spite of us.

At the hospital in The Overdose, “They eliminated the step of the pharmacist checking on the robot, because the idea is you’re paying so much money because it’s so accurate.” We need to ensure that someone is still there to check on the robot. We need to retain human intervention.

 

Make this screen go away!

Anyone working in a modern hospital pharmacy has dealt with the complexity of most IT systems. Often, you know what you want to do, but just can’t get it done. You sometimes find yourself in a maze that seems to have no exit. The medication order you are trying to master becomes secondary to managing the system.

If you have ever taken the subway, you can probably relate. Recently, I traveled to Paris, France. My plan was to take a train from the Paris station to my next destination. I was told to take the Red line train, the A train. I knew the direction I wanted to go and as the train approached the station, I hopped on. All is well.

Not so fast. The Red Line split and headed in two different directions. I was on the wrong Red train.

The analogy I draw with the IT systems is the same. I know what I want to do, I know the train I want to take, but just can’t seem to get there. Take for example, a physician who enters an order for a PEDIATRIC patient, but the drug happens to have an ADULT pathway as well. If the physician chooses the adult pathway, the dose rounding may be different. Adult dose rounding could be to the nearest 10 mg instead of to the nearest 0.1 mg. Same drug, but with a very different outcome. In this situation, the responsibility to catch the error would land squarely on the pharmacist.

As difficult as it is for pharmacists, I think the complexity of IT systems also presents a clear challenge for physicians, especially residents. The true intent of the physician may be misinterpreted just because it was the wrong order set, the wrong panel, or the wrong patient category. That is exactly why, for us pharmacists, I will reiterate tenant #1 – Always assume the order is incorrect until it can be proven otherwise.

 

Can I do this with my eyes closed?

One of the greatest innovations in medication safety has been the introduction of barcode verification for dose preparation, medication dispensing, and dose administration. Barcode verification provides assurance that you have the right drug, in the right form, and in the right dose. It has definitely saved lives. The problem though, is the potential for the caregiver to become disengaged and detached from the process. Instead of reading the label, we just listen for the confirmation beep. When barcode verification becomes a substitute for reading the label, I believe we could actually be increasing the risk of medication error!

In The Overdose, the author points out that, “the nurse trusted something she believed was even more infallible than any of her colleagues: the hospital’s computerized bar-coding system.” This is why it is so important that we retain human engagement in every process.

Additionally, most electronic systems offer no help in identifying when there is actually a problem. There are so many false alerts that most experienced users pay little or no attention to them. Another reason to agree with Sully Sullenberger! To summarize his quote from this article: We need to be capable of independent critical thought and prioritize our warning systems so that important alarms don’t get lost in the shuffle. Check out this blog post including how Sully Sullenberger has also inspired us. We have even utilized that inspiration as a springboard for development at RxTOOLKIT!

 

It’s too big to fail?

As IT systems become more inclusive, it is sometimes impossible to tweak one aspect of the program without affecting another part of the program. Sometimes that second part could include a medication issue. For example, let’s suppose you want to create a tool that nursing can use during a pediatric crisis.  The tool is designed by nursing, programed by a non-healthcare professional, and then published. The tool really doesn’t affect pharmacy, so pharmacy is not consulted. What could go wrong?

In most instances, the medication files in an IT system would be set up using several different drug files: one drug file for adults, one for pediatrics, and one for NICU. If the programmer is unaware that there are three separate drug files and builds the application using only the adult drug file, all of the doses and concentrations could potentially be incorrect. This type of nuance is not always readily apparent to the people building or performing the QA checks on the final product.

It’s easy to see how individual silos within the programming team can lead to bad results simply because, “you don’t know what you don’t know”.

 

Where do we go from here?

So how do we move forward and deal with these issues? Here are my current recommendations:

1. Lower the expectations that your primary IT system can do everything. These systems are fantastic, but like everything else, there are things they do well and things that they don’t.

 2. There must be a balance between the operational process and IT capabilities. If you find yourself striking a disproportionate balance: stop, rethink, and readjust.

3. Don’t build a new process around IT capabilities. We should never expect IT capabilities to supersede operational process. IT solutions should integrate with your established process.

4. Observe how your staff is really using your technology. If you observe that your staff has become disengaged; it’s time to re-train and re-engage.

5. Whenever there is a process or programming change and medications are involved, include pharmacy in the development team. This applies even if the new process was not built for or will not be utilized by pharmacy.

6. Don’t give up on the humans. Knowledgeable users who are engaged in the operational process are absolutely necessary for positive outcomes.

7. Don’t give up on the humans. (This is worth repeating!) There are qualified and conscientious people out there who care about doing the job correctly and accurately. These are the folks you want on your team!

Filed Under: Medication Safety, Pharmacy Technology Tagged With: awareness, barcode scanning, medication error, medication safety, patient and provider safety, pharmacy technology, RxTOOLKIT, working conditions

It’s Time for Pharmacy to Find Ways to Collect and Share Information – by Jerry Fahrni

August 27, 2015 by admin Leave a Comment

A big thanks goes out to Jerry Fahrni for giving us permission to reprint his post. We couldn’t agree with him more. In fact, many of the points he brings up are actually issues we have already solved with RxTOOLKIT® applications:

RxCONNECT™ our secure HIPAA compliant internal communications tool also used to monitor and document pharmacy refrigerator status

RxDOCUMENT™ our searchable document management system used for online data collection and organization

RxPACK™ our easy online logbook for bulk labeling, repackaging, and inventory management

All of our applications include robust search and reporting features.

Here’s the full article, It’s Time for Pharmacy to Find Ways to Collect and Share Information, originally posted on August 14, 2015:

 

Regardless of what everyone thinks, the healthcare industry is in the infancy of “big data”. The concept isn’t new, but we still have a long way to go, especially in pharmacy. I recall sitting at conferences years ago listening to sessions describing data collection and manipulation. The problem has been that data, especially that found in pharmacies is scattered across disparate systems without an effective method for connecting the dots. The adoption of electronic health records (EHRs) has made things better, but much of the data collected in an average acute care pharmacy is outside the EHR’s reach.  And to say that most pharmacies have their collective heads buried in the sand, would be putting it kindly.

Those on the outside often find it difficult to understand the sheer volume of data that’s produced in a pharmacy. Unfortunately, the data sources are mostly stored in disparate systems creating silos, which makes each system blind to the others. Is is possible to connect the systems and exchange data? Sure, but few if any are doing it.

Data sources in pharmacies come from places like clinical interventions, inventory management, cost containment strategies, regulatory compliance, internal communications, and so on.

Take for example the simple goal of managing all the drugs used in an acute care pharmacy. It’s not uncommon for pharmacies to have several sources of data from various systems within the pharmacy:

  • Room temperature items stored on shelves, carousels, or robots.
  • Refrigerated and frozen items stored in refrigerators or freezers that may be tied to the room-temperature inventory management system, or maybe not. Refrigerated and frozen medications may use a completely different method such as an RFID-enabled cabinets tied to a secondary source of control.
  • IV room inventory may be tracked, or more likely not tracked, once it leaves the “main pharmacy” area. It’s not uncommon for me to see IV room inventory treated as a location in which inventory is sent, i.e. no longer in inventory when it hits the IV room.
  • Controlled substances, the bane of pharmacy productivity, is stored and managed separately from all other medications. Does it have to be? No necessarily, but the currently accepted practice is driven mainly by regulatory compliance and fear. Don’t you think it’s entirely possible to design a system that would more easily manage controlled substances? Of course! But that’s not the way we roll. We prefer the most difficult, least efficient system possible. Mission accomplished, because that’s exactly what we have.
  • Management of medication kits, trays and transport boxes (trays). The amount of inventory stored in these trays is significant, and are often lost from pharmacy oversight upon reaching clinical areas. It’s amazing that medication trays are exactly the same as when I jumped into pharmacy practice nearly 20 years ago. It’s shocking just how poorly this area of pharmacy is managed. Some of my thoughts on the process can be found here.

Consider the amount of effort that goes into data collection for the soul purpose of regulatory compliance. Things like refrigerator and freezer temperatures, air flow and pressure differential in the cleanroom, documentation of blackbox warning drugs, and so on forever, create a mountain of information that is often collected on paper and stored in binders in some forgotten area of the pharmacy. It’s amazing in this is often considered best practice. I’m certain that much of this can be automated. Do other industries use such an antiquated system for data collection? I don’t know, but it shouldn’t be too difficult to find out.

I’ve mentioned only operational data to this point. What about clinical intervention data or financial information? The list goes on. Do pharmacy interventions really impact patient care in a positive way? I don’t mean in soft dollars, I mean in genuine, life altering ways? Possibly, at least in small studies. How about on a large scale? Don’t know. Can pharmacists actively improve pharmacy operations or the bottom dollar when engaged as part of the healthcare team? Don’t know.

What’s worse is that the data collected from all areas of pharmacy is rarely, if ever, pulled out of silos and incorporated into other data sets. What’s the value of that, you ask? Trends. It’s obvious to me that there are things within pharmacy data that we fail to see because the information is never compiled, stripped, joined, and analyzed. How big is the ripple effect of making a formulary change? Hard to say without looking at large groups of targeted data.

It’s staggering to think of what we’re missing by not taking full advantage of the data being generated in a pharmacy each and every day. Not to mention what could be found by compiling data from several, or several thousand pharmacies at once. The value of collecting and digesting massive amounts of data from national, regional, and local pharmacy practices is infinite.

Imagine being able to build true data-driven practices in both the clinical and operational pharmacy activities. Is there value in documenting that a patient is taking a drug with a black box warning? Maybe, but we don’t know. All we know is that some regulatory agency said we have to do it, so we do. But does it prevent anything? Who knows. Does drawing vancomycin troughs before the fourth dose improve outcomes, prevent toxicity, and decrease morbidity? Based on what I know, I think so. Has any of that ever been proven? Perhaps on a small scale, but nothing that I’m aware of that involves millions of data points. Then why do we do it? Because that’s the way it’s always been done. That’s the true definition of a non-data driven practice.

Is there a “best” way to handle sterile compounding? Is there a “best practice” for monitoring patients on heparin? I’m not talking about guidelines based on expert opinion, here. What I want is for someone to compile data from thousands of pharmacies across the country and really take a hard look at what’s is being done in pharmacies.

We’re seeing some of this in practice areas like UCSF’s precision medicine and many pharmacogenomics programs across the country. We should take their lead and apply those methods across the board. Data is power, and that power can be used to improve pharmacy practice. It seems to me that we have the ability, but thus far have failed to execute.

Someone call Google. They have a kind of data collection thingy, right?

 

 

Filed Under: Medication Safety, Pharmacy Technology Tagged With: awareness, Communication, medication safety, organization, patient and provider safety, pharmacy technology, prevention, RxTOOLKIT

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