❃
The Pharmacist’s News Source
pharmacypracticenews.com
Dedicated Team Helps To Improve Outcomes In Severe Sepsis Patients Miami Beach, Fla.—A multidisciplinary team that concentrates solely on managing severe sepsis can significantly improve patient outcomes, according to new research presented at the Society of Critical Care Medicine’s 39th Annual Critical Care Congress. The strategy improved the recognition of sepsis, reduced hospital length of stay (LOS) and lowered sepsis-associated mortality, according to lead author Audis Bethea, PharmD, BCPS, clinical pharmacy specialist, trauma surgery, Charleston Area Medical Center (CAMC), in West Virginia. The 893-bed center, which consists of three distinct hospitals, began to develop a multidisciplinary team, called the Sepsis Steering Committee, in 2005. CAMC wanted to improve its sepsis mortality rate, which ranged from 35% to 45%. “Mortality rates from sepsis can range anywhere from 20% to 60%, depending on how far the disease has progressed,” Dr. Bethea told Pharmacy Practice News. “For severely septic patients, average mortality rates can range from 30% to 50%. We were within that
•
see SEPSIS TEAM, page 29
When Choosing Antibiotic Regimen, Location Is Key New Study on susceptibility testing deemed practice-changing Miami Beach, Fla.—A three-drug regimen consisting of double gram-negative coverage plus methicillinresistant Staphylococcus aureus (MRSA) coverage is a must for increasing the success of proper initial empiric antibiotic selection, according to a study presented at the Society of Critical Care Medicine’s 39th Annual Critical Care Congress. What the regimen should consist of depends on the organisms that are most commonly found in each institution, according to lead investigator Jeffrey Barletta, PharmD, clinical specialist, critical care, at Spectrum Health in Grand Rapids, Mich. “Understanding the infectious epidemiology that is unique to your particular unit is crucial to this process of optimizing infection-related outcomes in critically
•
see MRSA TESTING, page 25
in this issue Clinical
ASHP Pearls Tips for boosting safety of HIV drug therapy, a genetic test for predicting potentially fatal drug reactions, and more.
Volume 37 • Number 3 • March 2010
❃
Reimbursement, Shortages And REMS, Oh My! Hem/onc pharmacists take pulse of practice
4
Hem/Onc Pharmacy Bisphosphonates may prevent breast cancer.
10
BCIRG 006 study fuels debate over anthracyclines for breast cancer
14
Critical Care Wake-up-and-breathe protocol for ventilator weaning still lagging.
20
One hospital’s success with adding pharmacists to the emergency department.
22
Fungal sepsis remains an unrecognized danger in ICU.
25
Policy
Joint Commission More delays in revising medication reconciliation patient safety goal.
34
Operations & Mgmt
R
eimbursement, off-label use and drug shortages are among the issues weighing heavily on the minds of hematology/oncology pharmacists as the government ushers everchanging policies into the new decade. The pace of those changes is a problem for many clinicians. As drugs are fast-tracked, for example, evidence of efficacy often mounts faster than the FDA’s ability to recommend changes in labeling. The result? Pharmacists, whose role in drug safety and patient educa-
Leadership in Action Emotional intelligence: Do you have it?
36
Process Improvement “Lean” management techniques boost pharmacy efficiency.
42
Educational Review
Safe Handling of Hazardous Drugs Insert after page
24
tion already is virtually ignored in reimbursement calculations, face an uphill battle in recouping costs. As if that wasn’t enough, pharmacists are bracing for a slew of risk evaluation and mitigation strategies (REMS) that may soon fall onto their shoulders. In the weeks leading up to the sixth Annual Conference of the Hematology/Oncology Pharmacy Association (HOPA) in New Orleans, several leading specialists discussed these practice issues with Pharmacy Practice News.
•
see PRACTICE PULSE, page 12
Haiti Relief Aboard USNS Comfort Pharmacists help naval ship deliver post-earthquake care
M
ixing a steroid drip for a patient with a spinal cord injury and preparing hypertonic solutions to reduce intracranial swelling caused by traumatic head injury were among the potentially lifesaving services delivered by pharmacists working on board or in conjunction with the U.S. Navy hospital ship USNS Comfort during the demanding early
days of the ship’s earthquake relief mission in Haiti. Working 14-hour shifts around the clock, the phar macy staff on the USNS Comfort filled some 3,000 orders per day at the peak of demand, according to Cmdr. Michael Volstorf, MSC, RPh, director of pharmacy aboard the 1,000bed floating hospital. Although many
•
see USNS COMFORT, page 40
New Product Tykerb approved for combo therapy in HER2-positive breast cancer.
See page
3