on
F
D in Bre Av A di a ca st as ti Se tio ca e n nc n: pa in er ge p 37 eri l
c
The Pharmacist’s News Source
pharmacypracticenews.com Printer-friendly versions available online
IT, drug safety featured
A Larger String Of Pearls Bestowed At ASHP Midyear Anaheim, Calif.—The pearls sessions held during the ASHP Midyear Clinical Meeting have become so popular that they’ve been expanded to cover topics including safety and quality, informatics and emergency medicine, in addition to the traditional clinical pearls. This is the first in a series of articles covering highlights of these pearls sessions.
Bigger Automation Rollouts May Trigger Bigger Problems
T
he far-reaching multicomponent automation systems that many hospitals and health systems are implementing present opportunities for far-reaching mistakes, according to medication safety consultant Mary E. Burkhardt, MS, RPh, FASHP. “The bigger we are, the harder we fall,” cautioned Ms. Burkhardt during the informatics
•
Volume 38 • Number 1 • January 2011
c
McMahon Publishing
in this issue Clinical
Medication Safety Hospital slashes hydromorphone error rate, wins ISMP Cheers Award.
5
‘Natural’ supplements can lead to potentially deadly atrial fibrillation.
16
NEW FEATURE!
Case Report Topical arnica and warfarin pose serious herb–drug interaction.
18
Opinion
Leadership in Action Having to read your boss’s mind not a good thing, according to Ernest Anderson Jr., MS, RPh.
Worst Drug Shortage Ever Puts Cancer Centers in Crisis Hem/onc pharmacists, physicians cite treatment delays that could compromise patient safety
A
n unprecedented nationwide shortage of chemotherapy drugs has left many cancer centers scrambling to prioritize their patient loads, snarled some clinical trials and delayed treatment for at least some patients. As of the first of December, 199 new drug shortages had been identified for 2010, according to Erin Fox, PharmD, who coordinates the Drug Information Service at the University of Utah Healthcare Hospitals and Clinics, in Salt Lake City. By comparison, “we only had 166 new short-
ages for all of 2009, and 149 for 2008,” she said. Chemotherapy drugs make up an alarmingly high percentage of the medications in short supply—a potentially dangerous subplot to the general shortages reported earlier this year by the Institute for Safe Medication Practices (ISMP). “That’s one of the things that makes this year so concerning and such a challenge,” Dr. Fox said. “To date, we’ve had 20 shortages of chemotherapy drugs. It’s never been nearly that
•
see SHORTAGES, page 8
20
see PEARLS ROUNDUP, page 13
Policy
To Err Is Still Human: Medication Errors Are A Persistent Challenge
M
ore than a decade has elapsed since the Institute of Medicine (IOM) published its landmark report on medical errors, “To Err Is Human,” which found that as many as 98,000 people die as a result of preventable medical errors every year. After 10 years of intense focus on quality improvement in health care, you’d think things might have gotten better. But according to two new studies, they haven’t. A recent report from the Department of Health and Human Services’ (HHS) Office of Inspector General (OIG) found that 13.5% of Medicare beneficiaries—134,000 patients—experienced some type of adverse event during a sample month (October 2008). Some 15,000 patients
•
see ERRORS, page 4
FDA Watch First new lupus treatment since 1950s nears approval.
40
Technology
Practice Pearls Effective leadership can help ensure successful CPOE adoption.
45
Supportive role can be fertile ground for pharmacists
Educational Review
Immune Globulins: Therapeutic, Pharmaceutical, Cost, and Administration Considerations see page
Preserving Pregnancy Options In Cancer Patients an Unmet Need
23
T
he cancer patient, a young man, was engaged to be married. But fighting cancer wasn’t the only issue on his mind. He also wanted to know if the treatment would undercut his ability to have children one day, recalled Sandra Cuellar, PharmD, BCOP, clinical oncology pharmacist at the University of Illinois
Medical Center in Chicago. “So the physician comes to me and says, ‘What do you know about Gleevec and fertility?’ ” It’s not the first time in the past few years that Dr. Cuellar has combed the medical literature, searching for clinical insights into potential fertility risks, as treatment options continue to multiply
•
The Book Page Anticoagulation Therapy: A Point-ofCare Guide William E. Dager; Michael P. Gulseth; Edith A. Nutescu See page
22
see FERTILITY, page 34
New Product Cactus SMART SINK™ prevents the unauthorized use of unused or waste drugs. See page
39