Health System

With greater responsibility for the pharmacy profession ought to come greater recognition. That was the message at the 10th annual ASHP Conference for Leaders in Health-System Pharmacy held recently in Chicago.

The fast-paced complex environment of a hospital critical care unit presents significant patient safety challenges for healthcare practitioners. High-risk decisions are often made with incomplete patient data, and, because patients require high-intensity care, if something goes wrong, they have a higher risk of getting hurt.

Deep vein thrombosis (DVT) and pulmonary embolism (PE) are on the way out. Not the conditions, which represent one of the most significant causes of hospital-associated morbidity and mortality, but the names. The familiar terms DVT and PE are being replaced with a broader term, venous thromboembolism, or VTE.

Saying it's an exciting time for the use of medications to treat opioid addiction, the federal Substance Abuse & Mental Health Services Administration (SAMHSA) has released a protocol giving details of the clinical pharmacology, screening, treatment matching, and other aspects of recommended use.

According to the National Center for Health Statistics, premature births are at a record high. Combine that fact with the reality of the crowded living conditions in the wake of recent hurricanes and we may have a recipe for respiratory syncytial virus (RSV) disaster this coming season.

A 70-year-old man, P.A., is seen in your ER with burning, stabbing, shooting pain on his lower back. He has recently had shingles; the emergency physician diagnoses his current discomfort as postherpetic neuralgia (PHN). The physician is debating what to prescribe and asks your opinion. You note from the patient's history that P.A. also takes donepezil (Aricept, Eisai) 10 mg, digoxin .125 mg, and benazapril 20 mg daily. What do you recommend?

The panel advised against the use of fluticasone with ritonavir because the combination resulted in significantly reduced serum cortisol concentrations.

Most surgeons misuse antibiotics most of the time. That is the blunt warning from Robert Sawyer, M.D., codirector of the surgical trauma intensive care unit at the University of Virginia Health System. The problem is not ignorance of appropriate use, he told the American College of Surgeons Clinical Congress meeting in San Francisco recently.

The treatment of elevated blood pressure reduces the incidence of stroke and leads to a significant reduction in mortality and morbidity among patients with cardiovascular problems. Although the beta-blockers are among the most widely prescribed medications for blood pressure control, not all hypertensive patients show benefit from taking these drugs.

Pharmacy residents can expect not only new standards in program requirements but also changes to the nomenclature of residencies. ASHP has approved the new standards for the accreditation of pharmacy residency programs at a time when the demand for postgraduate training programs is on the rise. The revised accreditation standards are scheduled to go into effect in January of 2007. They will replace the existing ASHP standards.

Patients with myelodysplastic syndrome (MDS) should be tested frequently for iron overload, a common, toxic side effect of repeated red blood cell transfusions. Patients with serum ferritin levels of 1,000 ng/ml to 2,000 ng/ml should be treated with iron chelation therapy, according to a new consensus statement, developed following a conference in Japan earlier this year. The new guidelines, published in a July 2005 supplement to Hematology-Oncology Clinics of North America, offer the first recommendations on the treatment of iron overload in these patients.

In the mid-1800s, Lady Sarah Winchester spearheaded the building of the bizarre California mansion that bears her name. While she did have a flair for design, her spontaneous plans and the results proved chaotic. Staircases led nowhere. Many doors opened to walls or steep drops, and a few bathroom doors had windows. The Victorian anomaly may be fun to visit, but it would be frustrating to live in.

Early in his pharmacy career Victor Perini, R.Ph., hadn't planned on becoming a hospital executive. But as he reflects on his current position as VP of operations at Methodist University Hospital in Memphis, Perini attributes his rise in the executive ranks to a combination of taking advantage of the right opportunities when they came along and the comprehensive training that he received in pharmacy school at the University of Wisconsin.

Of the 3,197 sentinel events JCAHO has reviewed from January 1995 through June 30, 2005, almost 11%, or 326 incidents, involved a medication error, making it the fourth most common type of sentinel event reported.

Baxter Healthcare Corp. has received a second Food & Drug Administration Class 1 recall in less than four months for its Colleague Volumetric Infusion Pumps. The FDA's Sept. 19 recall relates to pump battery excessive discharge and swelling failures, which cause the devices to become incapable of operating on battery power for the expected amount of time. This leads to interruption or prevention of therapy and possible death or injury. Baxter said it has received reports from customers that the problem may have been associated with four deaths and 10 serious injuries.

VHA has resurrected a familiar method for hospitals to save money: Trim pharmacy costs. But instead of urging its 2,400 member hospitals to simply slash pharmacy budgets, the not-for-profit hospital alliance is helping members save by shifting prescribing practices.

What's in a name? Plenty, it seems, when it comes to medications.

A huge focus on patient safety, a severe nursing shortage, and a shift in philosophy about how traditional medicine has come to view the role of pharmacy have led to health-system pharmacists playing a much larger role in critical care and emergency medicine. Nationwide, especially at large tertiary care centers, pharmacists have become permanent and welcome members of healthcare teams in intensive care units, trauma centers, and coronary care units. The demand for pharmacists is so great that some facilities have developed critical care residencies for pharmacists.

When the Gulf Coast was hit by hurricane Katrina in early September, hospitals and clinics were overwhelmed with seriously ill patients. Fortunately, overburdened healthcare systems in Louisiana and Mississippi got some relief when a number of states pitched in and offered to take on some of the patient overload.

Current safe-handling procedures for vials containing chemotherapy products are apparently insufficient. Recent U.S. and European tests have determined that product residues adhering to the outside of chemotherapy vials are a pharmacy hazard.

New study results published in the Lancet in September found that the use of drug-eluting stents (DESs) may be less cost-effective than bare-metal stents when used in all angioplasty patients. The results indicate that use of DESs should be limited to elderly patients in high-risk groups.

Patients with myelodysplastic syndrome (MDS) should be tested frequently for iron overload, a common, toxic side effect of repeated red blood cell transfusions. Patients with serum ferritin levels of 1,000 ng/ml to 2,000 ng/ml should be treated with iron chelation therapy, according to a new consensus statement, developed following a conference in Japan earlier this year. The new guidelines, published in a July 2005 supplement to Hematology-Oncology Clinics of North America, offer the first recommendations on the treatment of iron overload in these patients.

A recent study examining the relationship between diabetes, depression, and death demonstrates a need for diabetes patients and pharmacists to be familiar with the symptoms of depression. "We know that people with diabetes who have depression are at a much greater risk of mortality than similar people without diabetes," said Xuanping Zhang, Ph.D., a researcher with the National Center for Chronic Disease Prevention and Health Promotion at the Centers for Disease Control & Prevention in Atlanta. "Pharmacists and physicians have a professional obligation to let patients suffering from diabetes and depression know of this risk. Absence of intervention can be life-threatening."

A 60-year-old African-American male, G.H., is admitted to your hospital with shortness of breath, peripheral edema, and 10-lb. weight gain, diagnosed as New York Heart Association Class III heart failure (HF).

Central among sessions at this year's European Society of Cardiology 2005 Annual Meeting, held in Stockholm, Sweden, were those focused on the pharmacological treatment of myocardial infarction (MI). Noteworthy among those were two meetings looking specifically at the risks of such therapy, one at timing, and a fourth at an attempt to combine therapies already proven to be successful separately.

The latest science on the diagnosis and treatment of osteoporosis was the focus of many reports from the annual meeting of the American Society for Bone & Mineral Research (ASBMR), held in Nashville late last month. Here are some of the highlights.

Stroke, which results from decreased blood flow to a portion of the brain, remains a leading cause of disability and mortality in America. According to the American Stroke Association, many patients do not recognize acute stroke symptoms and most institutions lack the necessary structure to promptly and efficiently manage stroke patients.

There are a lot of lessons to be learned in the aftermath of Hurricane Katrina. Pharmacists who weathered the experience shared with Drug Topics their take on what went right and what went wrong, so that in the future, risks to patient safety could hopefully be kept to a minimum.

More than half of discharged hospital patients know neither their diagnosis nor the medications they have been prescribed. So concluded a study of patients released from a New York teaching hospital. The study, published by Mayo Clinic Proceedings in August, does not surprise Eric Coleman, M.D., who has studied the breakdowns in care as patients are moved from one setting to another. Coleman is associate professor of healthcare policy and research at the University of Colorado Denver and Health Sciences Center and consultant for the Joint Commission on Accreditation of Healthcare Organizations.

Health-system pharmacists have enough on their plate with clinical issues. But, like it or not, many pharmacists are starting to pay closer attention to revenue cycle and billing concerns. And if they're not, they'd better start. At least that's the advice from some industry experts.