THERE’S JUST NO SUBSTITUTE
Accurate dosing Reduced compounding time Barcoded dispensing containers Pleasant strawberry flavored suspension
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in this issue UP FRONT
4
Low-dose steroid option approved for asthma, COPD, RA and other conditions.
POLICY
6
8
Drug-tracking registry targets diversion, helps monitor recalls. FDA rejects Congressional claims that it’s to blame for drug shortage crisis.
CLINICAL
13 14
Study supports tadalafil use in pediatric pulmonary arterial hypertension. Tips for dealing with fallout from negative interferon/ MS trial.
OPERATIONS & MGMT
22
Ernie Anderson Jr.: conflict management starts at the top.
EDUCATIONAL REVIEW
Evolving Treatment Paradigms in Non-Small Cell Lung Cancer Visit pharmacy practicenews.com
Volume 39 • Number 9 • September 2012
40th ANNIVERSARY YEAR 1972–2012
Med Management Standards From JC Still a Challenge
Automation Shines Light On ‘Black Hole’ of OR Drugs
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Bedside drug carts speed access, reduce diversion risk
ear after year, the same medication management standards head the list for noncompliance during Joint Commission surveys. “The top [medication management-related] standards for noncompliance haven’t changed in 10 years,” according to Darryl S. Rich, PharmD, MBA, FASHP. “Organizations continue to struggle with medication security, medication orders and pharmacist review of orders.” In a recent online seminar, Dr. Rich reviewed the most problematic medication management standards, as well as new requirements, current interpretations of key standards and strategies to increase compliance. At the time of his presentation, Dr. Rich was a Joint Commission surveyor, but he has since joined the Institute for Safe Medication Practices, in Horsham, Pa., as a medication safety specialist. According to Dr. Rich, the standards that ranked highest for noncompliance include medication storage (33%
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see JC UPDATE, page 9
Fidaxomicin Slows Cancer-Related C. difficile Diarrhea High cost remains a barrier London—For cancer patients with Clostridium difficile–associated diarrhea (CDAD)—a common and troublesome complication—fidaxomicin is more effective than standard vancomycin therapy at producing a clinical cure and keeping patients symptom-free over a sustained period of time, according to a presentation at the European Congress of Clinical
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Baltimore—Ask pharmacy directors to cite a major safety or regulatory concern, and lack of control over medications used in the operating room will be on nearly everyone’s short list, according to Stephen L. Speth, RPh, the pharmacy manager at Indiana University Health Bloomington Hospital (IUHB), in Bloomington. “For quite some time, this was a black hole for us,” Mr. Speth said. “I felt we had decent control of pharmaceuticals, but you never really know what goes on behind closed doors when there is no real-time information on medication use and little to no pharmacist oversight.” That all began to change in March 2011, when IUHB placed automated anesthesia dispensing carts (ADCs) in its 14 ORs. By 2012, the strategy had achieved major gains in several medication management outcomes, including a 90% decrease in controlled substance discrepancies and a more than 50% reduction in the time needed for cart restocking, Mr. Speth reported in a poster (41-T) at the 2012 Summer
see FIDAXOMICIN, page 16
see BLACK HOLE, page 18
Pharmacist Interventions Fall Short In Avoiding Heart-Patient Med Errors
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ntervention by pharmacists, in ncluding efforts to help patients wh ho have low health literacy, did no ot significantly reduce a high ratte of clinically important medi-cation errors and preventable adverse drug events (ADEs) in a randomized controlled trial of cardiac patients. Of these patients, 50% had a significant medication error within one month after dis-charge from the hospital, accord ding to the study, published in the
Annals oof Internal Medicine (2012;157:110). In a small but troubling percentage of paatients, the missed errors were severre enough to result in trips to the emeergency room. The error rate did not decline T siignificantly with efforts by pharmacists to ensure prescribing m aaccuracy, educate patients during hospitalization and at discharge, h and follow up by phone with patients at home. The study was conducted at
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The Book Page Best Practices for Hospital and Health-System Pharmacy 2011-2012
see INTERVENTIONS page 20
New Product
American Society of Health-System Pharmacists
Teva Health Systems introduces Methotrexate Injection, USP.
See page 21.
See page 14.