(AHRQ) Medical Errors & Patient Safety Update

Great idea to standardize evidence of interventions

(AHRQ) Medical Errors & Patient Safety Update -

Agency for Healthcare Research and Quality (AHRQ) Medical Errors & Patient Safety Update

AHRQ Awards Contract to Develop Criteria to Assess the Evidence Base for Patient Safety Practices On January 8, AHRQ awarded a contract to develop a set of criteria to be used for assessing the evidence base for the effectiveness and safety of patient safety practices (PSPs) in future evidence reviews and for use by implementers of PSPs. The $1 million contract, Assessing the Evidence for Context-Sensitive Effectiveness and Safety of Patient Safety Practices: Developing Criteria was awarded to RAND, Johns Hopkins University, and the University of California-San Francisco, working in partnership with the Karolinska Institute (Sweden) and a technical expert panel. AHRQ recognizes that there is a need for a suitable set of criteria by which to assess which patient safety practices will work and are safe in specific settings. All across the country, providers, hospitals, health systems and policymakers are attempting to improve the safety of patient care, and are looking for guidance on what works. This 1-year initiative will be the first to take into account the complexity of patent safety interventions in the real world and tie those components to research and evaluation considerations. Those considerations include assessment of theoretical models for designing PSPs and the usefulness of innovative methods for evaluating intervention results. For more information, please contact the AHRQ Project Officer, Denise Dougherty, at Denise.Dougherty@ahrq.hhs.gov or 301.427-1868.

[Pharmacoinformatics Feed From Poikonen's Evernote]

Drug Induced QT Prolongation

Here is a series of articles on medication QT Prolongation. My sense is it is a under recognized problem, although I have no basis for this view, just a feeling.  This would make for an interesting CDSS to incorporate wave form analysis. 

Drug Induced QT Prolongation -

Editors' view

Drug-induced long QT syndrome and drug development

J. M. Ritter,

Department of Clinical Pharmacology, School of Medicine at Guy's, King's College & St Thomas' Hospitals, St Thomas' Hospital, Lambeth Palace Road, London SE1 7EH UK

Copyright Journal compilation © 2008 Blackwell Publishing Ltd

ABSTRACT

No Abstract

DIGITAL OBJECT IDENTIFIER (DOI)

10.1111/j.1365-2125.2008.03275.x About DOI

 

 

  Introduction

September's issue is themed around cardiovascular clinical pharmacology. It includes articles on a range of topics, spanning a review of the role of the renin-angiotensin system in atrial fibrillation [1], through the effect of atorvastatin on high-sensitivity CRP in acute coronary syndrome [2], and the pharmacokinetics and pharmacodynamics of nicorandil in healthy and acute heart failure subjects [3] to the influence of paraoxonase-1 (PON-1) phenotype on the response of paraoxonase activity to statins [4]. Several papers [5–7] relate directly or indirectly to effects of drugs on the electrocardiographic QT interval, and it is on this subject that this Editors' View is focused.

 

  The vulnerable period and the long QT syndrome

George Ralph Mines identified the 'vulnerable period' within the cycle of the cardiac action potential/pacemaker (or resting) potential [8]. (Mines [9], a contemporary at Cambridge of AV Hill, also described cardiac re-entry and identified the active principle of munchi arrow poison as strophanthin. He was appointed professor of physiology at McGill University in Canada aged 28, but died tragically soon thereafter – of which more later).

A ventricular extra beat falling early in the cardiac cycle, so that it coincides with ventricular repolarisation (the 'R on T' phenomenon), can provoke ventricular tachycardia (VT), and/or ventricular fibrillation (VF). The QT interval is measured from the beginning of the QRS complex (whether Q or R wave) to the end of the T wave. The latter may be difficult to define, especially when a U wave succeeds the T; however, the U wave tends to b...

[Pharmacoinformatics Feed From Poikonen's Evernote]

RxNorm and CMS in eRx 2009 Call Letter

It seem clear from this CMS correspondence that RxNorm will be replacing NDC codes (finally). It is time to contact your pharmacy system vendor to insure that they put the RxNorm code in their data structure. All of the major drug database vendors support the RxNorm CUI codes.
RxNorm and CMS in eRx 2009

Call Letter -

H. RxNorm CMS will continue to utilize a Formulary Reference File (FRF) and proxy National Drug Codes (NDCs) for HPMS submission of Part D formularies. For CY2009, CMS also will introduce the RxNorm nomenclature for the FRF drugs because we are exploring RxNorm as a potential alternative to proxy NDCs for formulary submissions in future years. RxNorm is a standardized nomenclature for clinical drugs produced by the National Library of Medicine (http://www.nlm.nih.gov/research/umls/rxnorm/index.html). CMS is working with the Page 60 60 National Library of Medicine to evaluate whether RxNorm would provide a more effective means of drug product identification for the FRF. CMS recognizes the value of a standardized nomenclature system for the purpose of Part D formulary submission and review and for its potential application as electronic prescribing evolves. For each CY2009 FRF proxy code, the RxNorm semantic names and RxNorm concept unique identifier (RXCUI) code (when available) will be included. Part D sponsors should be aware that FRF format changes will be forthcoming. CMS wishes to clarify again that the submission process for CY 2009 formularies will not involve the use of RxNorm concept unique identifiers. We will continue to investigate the benefits of using these codes for subsequent plan years. Should CMS determine that the utilization of RxNorm would be a beneficial means for indicating drug coverage during the formulary submission and review process for CY 2010, we will notify plans in the fall of 2008 of such changes.

[Pharmacoinformatics Feed From Poikonen's Evernote]

Rock and Roll Health IT Funding

The source of this report is interesting.  Time to turn up the amps to “11”

Economist's Letter to Obama Calls for Health Care IT Investment

In an open letter to President Obama published in the February issue of Rolling Stone, Nobel Prize-winning economist Paul Krugman calls for spending federal money "on things of lasting value," such as health IT, Healthcare IT News reports.

Krugman -- a professor of economics and international affairs at Princeton University and columnist for the New York Times -- writes that health care IT, "like similar infrastructure investments, would help create jobs," which then would address the economic crisis.

Krugman writes that Obama should "improve information technology in the health care sector, a crucial part of any health care reform."

Obama has said he wants to spend $50 billion over five years to support the adoption and use of health care IT (Monegain, Healthcare IT News, 1/19).

More Opinion and still lack of science on BCMA

This is getting downright weird.  I am starting to feel like Henry Fonda in 12 Angry Men, calling for real proof of decrease med errors rather than jumping on the BCMA bandwagon. 

New Report on Lessons from AHRQ-Funded Barcode Medication Administration Projects

The AHRQ National Resource Center for Health Information Technology has released a new report that summarizes key findings from grantees who have examined how applications such as barcode medication administration can improve the quality, safety, efficiency, and effectiveness of health care. The report focuses on lessons learned, challenges, and opportunities associated with introducing these applications into real-world clinical settings so that others who wish to implement and use barcode medication administration and electronic medication administration record technologies can learn from the experiences of these AHRQ projects. Select to access the report.

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Would like to hear reactions to the just released report.

My spin: It is my view that the statement below from the report does NOT support BCMA.

“Research has demonstrated successful reductions in the rate of medication administration and dispensing errors after the implementation of barcoding systems,8-16”

Reference 8 and 9 are on the dispensing process that are elegant and very convincing for the dispensing process not BCMA.

Reference 10-16 are not research studies showing reduction in errors but opinion pieces. They assume that BCMA will decrease errors and give commentary from that perspective. None of the references are research to show decrease medication errors. Something as important as this needs science not opinion.

8. Poon EG, Cina JL Churchill W, Patel N, et al. Medication dispensing errors and potential adverse drug events before and after implementing bar code technology in the pharmacy. Ann Intern Med 2006 Sep 19;145(6):426-34.

9. Poon EG, Cina JL, Churchill WW, et al. Effect of bar-code technology on the incidence of medication dispensing errors and potential adverse drug events in a hospital pharmacy. AMIA Annu Symp Proc 2005:1085.

10. Patterson ES, Rogers ML, Render ML. Fifteen best practice recommendations for bar-code medication administration in the veterans health administration. Jt Comm J Qual Saf 2004 Jul;30(7):355-65.

11. Wright AA, Katz IT. Bar coding for patient safety. N Engl J Med 2005;353:329-31.

12. Patchett JA. Bar coding: A practical approach to improving medication safety. ASHP Advantage; North Shore LIJ; Hospira; 2004:1-11.

13. Department of Health and Human Services: Food and Drug Administration. Bar code label requirements for human drug products and biological products; final rule. Federal Register 2004;69(38):201-601.

14. Department of Health and Human Services: Food and Drug Administration. Bar code label requirements for human drug products and biological products; final rule. Federal Register 2004;69(38):201-601.

15. The Joint Commission. http://www.jointcommission.org/. Accessed August 30, 2008.

16. Kohn LT, Corrigan JM, Donaldson MS. To err is human: building a safer health system. Washington, DC: National Academy Press; 1999.

If BCMA was a drug

So would you take a drug that had zero studies on its safety and efficacy?  Would labeling claims such as “over 24 million doses administered with zero serious side effects” have the wrath of the FDA down on them.

In light Coca-Cola being served with a class-action lawsuit, charging the Atlanta beverage giant with deceptive and unsubstantiated claims on its Vitaminwater beverages, consider Intellidot’s claim in a recent advertising.

“Our barcode point-of-care system has allowed our clients to deliver over 24 million medication administrations with zero serious five rights med errors.”

Intellidot is asking for and just might get into some deep do do over unsubstantiated statements such as this.  The studies to which they refer are internal, not peer reviewed and of a relative small sample size as admitted by the company in a ASHP list serv post.  Desperate times call for desperate marketing is my guess.

Nursing Informatics Conferences in 2009

Am Nursing Informatics Assoc. speaker proposals due January 25, for Las Vegas conference April 23-25, 2009.  They do not pay for anything but a registration, fyi.

http://www.ania.org/Speaker&Poster%2009.htm

Also found this http://www.ni2009.org/ The 10th International Congress on Nursing Informatics welcomes you to Helsinki Finland on 28 June – 1 July 2009.   Paper submission date has passed (bummer).

Helsinki is a wonderful place to visit, both as a historic, majestic city and summer solstice in Finland is quite a celebration.  Let’s have the 1st International Pharmacy Informatics Congress there in 2010.

Pharmacology in Second Life

Pass this on to your pharmacology profs (and watch them weep)

Pharmacology in Second Life

http://scienceroll.com/2009/01/15/pharmatopia-pharmacology-in-second-life/



I may have mentioned this before: This Medical Students blog is fantastic. Following him on Twitter is fascinating.

Pharmacoinformatics or Pharmacy Informatics Working Group

It has been kicked around in the AMIA working group that perhaps we should change the name of the working group. Currently it is the Pharmacoinformatics Working Group. Here are some some items for your thought and considerations. First is our mission statement:

Mission

To promote interaction among AMIA members who are interested in the intersection of technology and medication management. This includes all aspects of the process from prescribing, dispensing, administration, monitoring, and educating about medication use within health care delivery systems.

• Prescribing – clinical decision support to facilitate rational prescribing
• Verifying/Dispensing – interpretation, translation and perfection of medication orders, including informatics and technology in dispensing
• Administration – the information flow and decision support with electronic medication administration, 5 right checking and documentation
• Monitoring – relating to the use of ADE surveillance/prevention, pharmaco-epidemiology, pharmaco-vigilance and pharmacoeconomics to enhance patient outcomes
• Education – promoting professional and patient education

Here are some graphical representations. First is informatics defined by Ted Shortliffe.

This is an adaptation for pharmacy

Note that Pharmacy informatics does touch patients, society and then moves to professional pharmacy practice.

The next few diagrams are adaption from Terry Seaton's work. We discussed the exact location of each circle and could not exactly get it right. Both are submitted for your view.

and this one, that is a little bit different.

So the question remains. Pharmacoinformatics or Pharmacy Informatics.

The Best Medical Blogs for 2008

The polls are open to vote on the best Medical Blogs.

http://www.medgadget.com/archives/2009/01/the_2008_medical_weblog_awards_the_polls_are_open.html

Twitter List

http://www.medicalstudentblog.co.uk/twitter-doctors-medical-students-and-medicine-related/

If you are on Twitter, lets get the pharmacist list longer1