Hospital Pharmacy

These medication errors have occurred in health care facilities at least once. They will happen again—perhaps where you work. Through education and alertness of personnel and procedural safeguards, they can be avoided. You should consider publishing accounts of errors in your newsletters and/or presenting them at your inservice training programs.

Your assistance is required to continue this feature. The reports described here were received through the Institute for Safe Medication Practices (ISMP) Medication Errors Reporting Program. Any reports published by ISMP will be anonymous. Comments are also invited; the writers' names will be published if desired. ISMP may be contacted at the address shown below.

Errors, close calls, or hazardous conditions may be reported directly to ISMP through the ISMP Web site (www.ismp.org), by calling 800-FAIL-SAFE, or via e-mail at ismpinfo@ismp.org. ISMP guarantees the confidentiality and security of the information received and respects reporters' wishes as to the level of detail included in publications.

The purpose of this feature is to heighten awareness of specific adverse drug reactions (ADRs), discuss methods of prevention, and promote reporting of ADRs to the US Food and Drug Administration's (FDA's) MedWatch program (800-FDA-1088). If you have reported an interesting, preventable ADR to MedWatch, please consider sharing the account with our readers.

The complexity of cancer chemotherapy requires pharmacists be familiar with the complicated regimens and highly toxic agents used. This column reviews various issues related to preparation, dispensing, and administration of antineoplastic therapy, and the agents, both commercially available and investigational, used to treat malignant diseases.

This Hospital Pharmacy feature is extracted from Off-Label Drug Facts, a quarterly publication available from Wolters Kluwer Health. Off-Label Drug Facts is a practitioner-oriented resource for information about specific drug uses that are unapproved by the US Food and Drug Administration. This new guide to the literature enables the health care professional or clinician to quickly identify published studies on off-label uses and determine if a specific use is rational in a patient care scenario. References direct the reader to the full literature for more comprehensive information before patient care decisions are made. Direct questions or comments regarding Off-Label Drug Uses to jgeneral@kumc.edu.

Pharmacists appear to be increasingly turning to outsourcing as an option for managing drug preparation tasks, especially for sterile products whose preparation may be time- and labor-intensive. Outsourcing requires that the pharmacy carefully consider exactly what is being outsourced and why. In most cases, outsourcing provides less protection from liability than many pharmacists believe. To understand the risks of the outsourcing and how to manage the potential liabilities, it is important to understand where compounding practices started and how outsourced compounding vendors originated. Even though various resources exist to guide the evaluation of compounding outsource vendors, key decision makers (eg, hospital administrators, directors of pharmacy, the most responsible pharmacist) have no way to truly gauge the quality of outsourced compounding vendors unless they are properly regulated and the rules and regulations are clearly stated and available for review. Pharmacists should be prepared to investigate a potential outsource vendor and critically review their facilities, procedures, and documentation to ensure that dose preparation is properly performed and controlled. This article presents key performance quality indicators to review during a site visit to vet a possible outsourcing partner.

Each month, subscribers to The Formulary Monograph Service receive 5 to 6 well-documented monographs on drugs that are newly released or are in late phase 3 trials. The monographs are targeted to Pharmacy & Therapeutics Committees. Subscribers also receive monthly 1-page summary monographs on agents that are useful for agendas and pharmacy/nursing in-services. A comprehensive target drug utilization evaluation/medication use evaluation (DUE/MUE) is also provided each month. With a subscription, the monographs are sent in print and are also available on-line. Monographs can be customized to meet the needs of a facility. Subscribers to The Formulary Monograph Service also receive access to a pharmacy bulletin board, The Formulary Information Exchange (The F.I.X.). All topics pertinent to clinical and hospital pharmacy are discussed on The F.I.X.

Through the cooperation of The Formulary, Hospital Pharmacy publishes selected reviews in this column. For more information about The Formulary Monograph Service or The F.I.X., call The Formulary at 800–322–4349. The February 2012 monograph topics are on rivaroxaban in non-valvular atrial fibrillation, Zolpidem tartrate sublingual, aflibercept, glucarpidase, and mipomersen. The DUE/MUE is on Zolpidem.

This monthly feature will help readers keep current on new drugs, new indications, dosage forms, and safety-related changes in labeling or use. Efforts have been made to ensure the accuracy of this information; however, if there are any questions, please let me know at bakerdan@wsu.edu.

As you might expect, the vast majority of pharmacists are “packing” a smartphone. Most even sleep near their device (within about 3 feet). Gone are the days when a separate personal digital assistant (PDA) and a pager supplemented a clunky cell phone on our waists or in our purses. We are able to keep an information appliance on hand 24/7. In this installment, we discuss the ways we most commonly use our smartphones.

The Director's Forum series is designed to guide pharmacy leaders in establishing patient-centered services in hospitals and health systems. This article focuses on the Center for Medicare & Medicaid Service's (CMS) Value-Based Purchasing (VBP) program for hospitals. VBP links Medicare payments to the quality performance of acute care hospitals paid under the Inpatient Prospective Payment System (IPPS), for patient assigned to various diagnosis-related groups (DRGs). It is essential that pharmacy directors understand the implications of the VBP program and the subsequent opportunity that it creates for pharmacy. To take full advantage of the program, adjustments will need to be made in staffing, skill mix, and ultimately the design of the pharmacy practice model.

Hospital Pharmacy presents this feature to keep pharmacists abreast of new publications in the medical/pharmacy literature. Articles of interest regarding a broad scope of topics are abstracted monthly.