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The Pharmacist’s News Source
pharmacypracticenews.com Printer-friendly versions available online
in this issue OPERATIONS & MGMT
6 10
Centers of excellence revamp care transitions, cut 30-day hospital readmissions.
16
A pharmacisthospitalist partnership improves patient care and reduces cost.
CLINICAL
24 28
Pharmacogenetics, nanotechnology prove fertile ground for 2012 ASHP Foundation Literature Awardees. ISMP webinar: data-mining voluntary medication error reports may be key to boosting opioid safety.
TECHNOLOGY
48
Why it’s time to close the medication safety loop in emergency departments.
EDUCATIONAL REVIEW
Management of Gastroesophageal Reflux Disease See page 35.
40th ANNIVERSARY YEAR 1972–2012
After NECC, Whom Can You Trust?
A
Chicago hospital’s strategy for enhancing accuracy, safety of warfarin dosing.
Volum me 39 • Number 11 • November 2012
lthough the clinical fallout from the largest outbreak of illness ever tied to a pharmacy compounder is alarming, it may be the most straightforward to document. By Nov. 1, nearly 350 patients treated with an injectable steroid prepared by the New England Compounding Center (NECC) had been infected, with 29 fatalities reported in 19 states, according to health officials.
‘This is what keeps pharmacy directors up at night.’ —Tom Van Hassel, RPh, MPA But those numbers haven’t helped clear up more challenging questions. How, for example, could the Framingham, Mass., facility have been allowed to mass-produce compounded drugs and ship them across state lines, potentially in violation of state pharmacy laws? And why was NECC allowed to operate despite a history of safety violations—some involving the same steroid that has been implicated in the current outbreak? State boards of pharmacy, the FDA and compounding pharmacy trade associations have been cast as villains in allowing this regulatory morass to persist. With no fixes likely to emerge anytime soon—aside from NECC shuttered and Ameridose, which shares owners with NECC, voluntarily recalling all of its products—a more immediate question now looms for health systems that still need to buy compounded medications: Whom can you trust? “That’s certainly one of the key
•
see MENINGITIS, page 40
On the CUSP of Eliminating Central-Line Infections Pharmacists playy integral role in multidisciplinaryy effort
A
comprehensive unitt-based safety program reduced d central line–associated blood dstream infections by 40% in 1,100 intensive care uniits between 2008 and 20112. Some of the ICUs have remained free of these infections for more than two years—a statistic once thought unattainable by many clinicians. “With these resultts, health care is takingg a giant step forward,” saaid Peter Pronovost, MD, P PhD, the senior vice presid dent for patient safety and quality ty at Johns Hopkins Medicine, in Baltimore, who created the comprehensive unit-based safety program (CUSP). After initial evaluation of the program at Johns Hopkins in 2001,
CUSP was investigated at 100 centers in Michigan g between 2003 and 2005, and then promoted nationwide by the Agency for Healthcare Research and Quality (AHRQ).
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see CLABSIs, page 46
The Great Opioid Debate: PROP, PROMPT Square Off
S
hould the reins be tightened ened on the use of long-term opioid o therapy for patients with chrronic noncancer pain (CNCP)? That question is at the heaart of a controversy that has boilled over since July when 37 phyysicians in pain management, public health, psychiatry and other specialties issued a citizen petition calling on the FDA to require opioid label changes that would strike the word “moderate” from
The Book Page Handbook on Injectable Drugs: 17th Edition
CNCP opioid treatment indications and limit the drug’s use solely to severe pain—and then only for a maximum of 90 days at no more than the equivalent of 100 mg of morphine daily. The petition from Physicians for Responsible Opioid Prescribing (PROP) cited growing U.S. rates of opioid addiction and overdose deaths along with
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see OPIOID DEBATE page 26
New Product
Lawrence A. Trissel, FASHP
CareFusion, Cerner announce Pyxis Medstation® 4000 system and the Cerner Millennium® EMR.
See page 49.
See page 16.
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