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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 procedural information, 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 up-to-date, standardized, and easily “scanable” reference help to ensure your staff is familiar with both a drug and related dosing parameters. It’s easy to find a fast answer, there’s even a Quick Summary section, consolidating drug specific tools and providing quick reference, helping to confirm the necessary parameters 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

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

The Vital Role of Pharmacy Technicians — Chris Jerry, of the Emily Jerry Foundation

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The following post was written by Chris Jerry of the Emily Jerry Foundation. Chris tragically lost his daughter as a result of a preventable medical error made by a pharmacy technician. We are grateful to Chris for his courage in sharing his story as well as for the work he is doing to bring light to this important issue.

Before the loss of my beautiful daughter, Emily, to a tragic preventable medication error in 2006, like most people, I had no knowledge of the vital role that all pharmacy technicians play with respect to safe pharmacy practice. Shortly after Emily’s death, I decided to establish the Emily Jerry Foundation (EJF), in an effort to create awareness about preventable medical errors as well as to be an active part of the overall solution in preventing them.

I reached out to my friend Michael Cohen, from the Institute for Safe Medication Practices (ISMP), to help explain the overall function and responsibilities of a pharmacy technician. Michael imparted some words of wisdom by sharing an analogy that really hit home with me, one that I will never forget.

He said, “Chris, always think of pharmacy technicians as being the “team” and the supervising pharmacists as being the “coaches” in any pharmacy setting.” He went on to say, “What coaches wouldn’t want to have the best trained and most qualified team to ensure a successful and victorious season?” He then explained, that a truly “victorious season” in any pharmacy setting, can be equated to having no medication errors that actually reach a patient receiving care. That simple analogy made sense to me back then and still resonates with me today.

Due to the fact that pharmacy is really the only modality in healthcare that truly works in the background, especially in hospital pharmacy, like most people, I was naturally clueless as to the overall scope of practice that pharmacy technicians have in modern day pharmacy. For example, I had no idea that in virtually every one of our nation’s hospitals, pharmacy technicians have the important responsibility of compounding nearly ALL IV (intravenous) medications, which go directly into patient’s circulatory systems.

In addition, most states have little or no requirements in regards to pharmacy technician training or certification. On the EJF website, we have created an interactive National Pharmacy Technician Initiative and Scorecard, so you can see exactly how your state ranks.

I was absolutely horrified to learn that my little girl had died from a sterile IV compounding error, made on the part of a pharmacy technician, who did not have the proper training or core competency to know the difference between a standard bag of saline with 0.9% sodium chloride, versus hypertonic saline, which has a concentration of 23.4% sodium chloride.

Technically, my daughter tragically died as a result of being overdosed on hypertonic saline.

However, as Emily’s Dad, I feel as though what actually caused her death was a lack of understanding regarding the true importance and vital role that pharmacy technicians play on the clinical “team”, helping to ensure the best and safest possible outcome for each and every patient receiving healthcare.

This is precisely the reason why I feel so strongly that pharmacy technician training is a matter of life and death for all of us! As every single one of us will receive healthcare at some time over the course of our lifetimes.

Above all else, well trained, competent, and reliable pharmacy technicians can drastically reduce any facility’s overall medication error rate. We must fully support technician training and certification, and never ever forget the vital role that technicians play; there are countless lives at stake!

 

For more information about Chris Jerry and the Emily Jerry Foundation please visit: https://emilyjerryfoundation.org/

For more information on Pharmacy Technicians University or to enroll please contact elearning@rxtoolkit.com or visit https://rxtoolkitelearning.com/ptu/

Minimizing Risk with Standardized IV Care for the Infusion Center

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In recent years there has been a plethora of new infusion and injection therapies flooding the healthcare market. These new therapies are giving patients with chronic illnesses a broader range of treatment options and providing them the opportunity to live their lives with fewer debilitating chronic symptoms.

As an Infusion Center Nurse Manager, with over 25 years of nursing experience, I find the surge of new treatment options to be mind blowing. I still remember when new drugs seemed to take years in development. They would go through a lengthy approval process, including clinical trials, before a new therapy would be released to market and finally become available for patients.

Currently, the speed at which new infusion/injection drugs are approved, gives nurses little time to research and learn the important care points of preparation, administration, patient response to therapy, and patient assessment.

In addition, the days of learning nursing from our more seasoned nurses, thru tradition, and one-on-one training are dwindling fast. We are all out there on the front lines learning together. This makes the availability of reliable evidence based resources more important than ever.

RxTOOLKIT’s RxWORKFLOW™ for IV Safety is answering the call for those concise care points we nurses need in order to provide evidence based care safely and efficiently for our patients.

I have found RxWORKFLOW™ for IV Safety to be convenient and easy to use, providing the information nurses need, right when they need it! It prepares us to provide patients the best quality care:

  • Evidence based processes with quick links to resources ensure the information is credible, reliable, and up-to-date
  • Step-by-step instructions (including recommendations for all equipment needed) help me to prepare and administer the latest infusion/injection therapies
  • Having fast access to trustworthy and comprehensive information gives me confidence that I will do it right for my patients
  • Pop-up calculators ensure that calculations are done correctly and fall within accepted parameters for the drug

Before RxWORKFLOW™ for IV Safety, my nursing colleagues and I adopted fragmented processes to provide safe patient care:

  • Finding the time to research reliable information and learn the administration and preparation for IV medications was always challenging
  • We would carry index cards and pocket notes to help remember the key care points for many IV medications prescribed for patients
  • Keeping a paper binder up to date with all the requirements for each drug regimen was a constant struggle
  • We often sought the help of a colleague with experience in preparing and administering a drug that was new to us
  • Those of us not confident with math skills (myself included!) would often track down another nurse to double check any drug calculations

These fragmented, inconsistent processes lead to wasted time, distractions, and exponentially increased the risk for medication errors.

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 administration often results in the most serious outcomes of medication errors.2

The development of evidence based practices and standards of care are vital for successful outcomes in outpatient infusion centers. Training staff and keeping them up-to-date on the established guidelines is also imperative for success. RxWORKFLOW™ for IV Safety provides assurance that I have the right information and that I can provide proper training to maintain safety and quality care for my nurses and patients.

Please contact info@RxTOOLKIT.com or visit IVSafety.RxTOOLKIT.com for more information.

[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.

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

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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 :

 

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?