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Penicillin Allergies

Here is a really interesting study, per Jim Carpenter in Portland, on a very high documented true allergy rate of self reported Penicillin allergies in a ED.  91% of people that stated a PCN allergy did not have a IgE mediated response.  Wow, that sounds high to me. 

As Jim points out in his Twitter post, this may have significant implications for CDS alerting.  Some logic based on the patients condition and infection where a PCN or Cephalosporin may be the best choice might invoke a suggestion to do a skin test to determine if a true allergy exists.   The article has a table of potential cost savings.

http://www.annemergmed.com/webfiles/images/journals/ymem/asraja.pdf

How Twitter Changed by Life

Ok, this might be a stretch, my life has not changed all that much, but Twitter is fascinating. This slide show posted by Berci, famous for all things Medicine 2.0 is useful to introduce you to Twitter. btw my name on Twitter is "poikonen" -jp

http://scienceroll.com/2009/02/14/how-twitter-changed-my-life-slideshow/

How Twitter Changed My Life

View more presentations from Minxuan Lee. (tags: micro twitter)

Clinicians Ignore most eRx Alerts

What in medicine do we tolerance 90%+ false positive rates, without getting rid of it?
We have a long way to go in CDS.  Below is from a ASHP press release on a new Archives of IM study, recommended read.
-jp


Clinicians Ignore Most e-Prescribing Alerts
Kate Traynor

BETHESDA, MD 09 February 2009—A large study of electronic prescribing in the outpatient setting suggests that prescribers override most warnings that indicate a medication allergy or drug interaction, according to a report in the February 9 Archives of Internal Medicine.

The analysis of data for 2872 prescribers in Massachusetts, New Jersey, and Pennsylvania over a nine-month period in 2006 found that the clinicians accepted 23% of alerts for medication allergies and 9.2% of drug interaction alerts. Alerts were almost always ignored for medications that had been previously prescribed for the patient.

The study examined more than 3 million electronic prescriptions generated using Zix Corporation's PocketScript program. Of these, about 6.6% resulted in an interaction alert to the prescriber. Less than 2% of the alerts were for medication allergies; the rest informed the clinician that the selected medication potentially interacts with another drug currently taken by the patient.

Drug interactions were classified in the prescribing program as low, medium, or high severity, and the severity level was displayed on the prescribing device's screen. About 62% of the alerts in the study were classified as high severity, and 29% were of medium severity. High-severity alerts were overridden about 90% of the time, and lower-level alerts were disregarded about 93% of the time.

According to the report, PocketScript's severity classifications are produced by pharmacists at a health information technology company. The report's authors suggested that reexamining and reclassifying some of the high-severity alerts, particularly those that are most often overridden, may increase prescribers' acceptance of drug-interaction warnings.

Prescribers took some high-severity drug–drug interactions more seriously than others. For example, warnings not to use noncardioselective beta-blockers and macrolides together were accepted 43.1% of the time.

The next-most-commonl...

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Blogged with the Flock Browser

More on the BCMA AHRQ Report

I commented on a report by AHRQ on BCMA already in this post.  It does nothing to bolster the BCMA evidence.

Now on further examination the references are even more embarrassing than first thought.  Thanks to Brent Fox at Auburn that noticed this.  Check these sets of references in the report:

• 2, 16, 26
• 6 and 27
• 8 and 18
• 9 and 19
• 10 and 20
• 11 and 21
• 12 and 22
• 13, 14, 23, 24

Must be getting paid by the references.  More references = more credibility? Not.  Very disappointing from AHRQ, whose publications are usually first rate.

Patient Safety and a Tale of Two Pilots: US Airway’s Sullenberger and KLM’s Van Zanten

When a New York policeman commandeered a chopper after receiving a “plane down” distress call, he expected to find a Cessna or a Piper in the river. “I never, in a million years, expected to see US Airways in the Hudson,” said Sgt. Michael Hendrix when...(read more)

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AJHP versus NEJM

The Efficient MD - Life Hacks for Healthcare: Twitter Dispatches from the New England Journal of Medicine's Horizons Conference

I happened on this blog that is very interesting.  This post on what the NEJM is doing, struck me as something AJHP might consider. 

 

This initiative by NEJM is outstanding.  Clearly they are skating to where the puck is being shot, not to where it is now.

 

 

The New England Journal of Medicine is seeking to bring together a group of visionary medical students and trainees to help NEJM push the boundaries of traditional medical publishing. We are looking for creative minds to join the editors for a weekend to explore what's possible. We anticipate a vigorous dialogue around the ideas that invited participants and other speakers share with the group.

 

Twitter feed of the conference

http://search.twitter.com/search?max_id=1172796326&page=1&q=%23NEJM

 

My bias and unfounded perception is that AJHP is stuck in the mud a bit.  Part of this bias is the (weird) push back I have gotten on the Green Initiative passed by the HoD; right or wrong. 

Medication Errors Occurring with the Use of Bar-Code Administration Technology

Below is a very nice article on how to overcome workarounds and process improvement.

My 'beef' with this and many other bar code studies is that it assumes that BCMA is a good thing. This is a false assumption.

The studies and references in this paper do not support the benefit statements.

"Studies have shown that BCMA can reduce medication errors by 65% to 86%. 5,6,7 "

• *Reference 5 is a HIMSS presentation (no peer review)
• *Reference 6 is pure speculation piece in AJHP (no science)
• *Reference 7 is based on reportable errors. What if folks where so busy or ticked off that they did not report errors, post implementations. The author of this reference even has communicated to me that this study was never intended to be used as evidence for showing decrease errors.

Also: "one hospital in Pennsylvania showed that the direct-observation accuracy rate before BCMA was 86.5%; after BCMA, the rate rose to 97%.8"

• *This reference is a post study from complete manual to full eMAR and BCMA. What if 99% of the benefit was with eMAR and not bar coding?

Medication Errors Occurring with the Use of Bar-Code Administration Technology -

Medication Errors Occurring with the Use of Bar-Code Administration Technology

Pa Patient Saf Advis 2008 Dec;5(4):122-6.

Abstract

Bar-code medication administration (BCMA) systems can improve medication safety by verifying that the right drug is being administered to the right patient. Studies have shown that BCMA technology can reduce medication errors by 65% to 86%. But BCMA technology alone does not ensure a safe medication-use system. A number of reports submitted through PA-PSRS describe medication errors that occurred in organizations that used a bar-code system for administration. Some of these errors result from failures to use this technology appropriately, employing workarounds or overriding alerts, disruptions in the medication administration process, and dispensing errors that arise in the pharmacy. Strategies to address problems with this technology include reviewing BCMA logs to evaluate overrides and identify system weaknesses and monitoring and measuring compliance with the technology to identify and remove any barriers to its appropriate use.

A prospective cohort study of medication errors by Leape et al.1 determined that 39% of errors occurred during the prescribing phase, 12% during transcription, 11% during dispensing, and 38% during administration. Close to half of the errors that occurred during the prescribing phase were intercepted before they reached the patient; in contrast, only 2% of errors that occurred during the administration phase were intercepted. Another study using direct observation in 36 healthcare facilities found that medication administration errors occurred in almost 20% of doses administered.2 Data from U.S. Pharmacopeia’s (USP’s) medication error reporting database, MEDMARX®, indicates that an error at the point of administration is least likely to be intercepted before reaching the patient, compared to other phases of the medication-use process.3

One form of technology that may address administration errors is a bar-code medication administration (BCMA) system. BCMA c...

[Pharmacoinformatics Feed From Poikonen's Evernote]

Study: Health IT Use Can Lower Hospital Mortality Rates, Costs

Landmark study in Archives of Internal Medicine with nice editorial by David Bates.   I have some thoughts on what the pharmacy department might be doing in these hospitals where there was a difference in mortality; will post later.  Would like to see similar study on outcomes with and without BCMA (Hey – a guy can dream).

Study: Health IT Use Can Lower Hospital Mortality Rates, Costs - iHealthBeat -

Study: Health IT Use Can Lower Hospital Mortality Rates, Costs

Hospitals' use of health IT is associated with lower mortality rates, complications and costs, according to a new study published in the Archives of Internal Medicine, Reuters/Washington Post reports (Steenhuysen, Reuters/Washington Post, 1/26).

Study Details

The researchers divided clinical IT systems into four categories:

• Clinical decision support;
• Medical notes and records;
• Order Entry; and
• Test Results.

The researchers surveyed physicians at 41 urban hospitals in Texas about their use of IT systems in each of the four categories. The researchers then looked at the relationship between IT usage and the rates of inpatient death, complications, costs and lengths of stay for 167,233 patients ages 50 and older who were admitted to the participating hospitals in 2005 and 2006.

The study was funded by the Commonwealth Fund (Conn, Modern Healthcare, 1/26).

Study Findings

The study found that patients at hospitals that ranked highest in health IT use by physicians were 16% less likely to develop complications than patients treated at hospitals where physicians used IT less.

The study also found that patient mortality rates were 15% lower at hospitals that ranked highest in the use of software to automate patient records and notes.

In addition, heart attack patients had a 9% lower risk of dying and bypass patients had a 55% lower risk of dying at hospitals with high scores in use of software to track physicians' orders, according to the study.

"If these results were to hold for all hospitals in the United States, computerizing notes and records might have the potential to save 100,000 lives annually," Neil Poe of Johns Hopkins University School of Medicine, who worked on the study, said (Reuters/Washington Post, 1/26).

[Pharmacoinformatics Feed From Poikonen's Evernote]