Drug Topics- August 11, 2008

www.drugtopics.com AUGUST 11, 2008 DRUG TOPICS HSE 1 Hospitals face new reconcilation, anticoagulation goals Mark Lowery E ven as hospital pharmacists referring provider. Hospitals and are struggling to meet preother medical facilities across the vious mandates, the Joint country have tried various tactics to Commission has released 2009 prevent medication reconciliation National Patient Safety Goals— errors. For example, pharmacists including revisions to medication at a Midwestern academic medireconciliation and anticoagulation cal center used a pilot program standards—that may prove burinvolving telephone and follow-up densome for some practitioners. interventions. Patients included in The new requirements include that program had been prescribed the implementation of practices more than five medications (inBona Benjamin to prevent hospital-acquired infeccluding one high-risk), had been ASHP tions due to multiple drug-resistant discharged to home, had working organisms. Full implementation of telephone service, and spoke Engthe requirements is expected by the beginning of lish. Patients were contacted by telephone within 72 2010. Other significant changes involving pharma- hours of release and at 30 days to identify post-discists are revisions to the medication reconciliation and charge medication-related problems. A total of 486 anticoagulation standards. “The way the new goals discrepancies were found and resolved in 63% of the are stated, they give pharmacists better guidance,” patients—an average of three discrepancies per paBona Benjamin, B.S. Pharm., director, medication- tient. The most common discrepancies were missing use quality improvement at the American Society of medications, failure to discontinue unnecessary or Health-System Pharmacists, said. But “many pharma- inactive medications, and wrong dosage/frequency. cists are still struggling with [the 2008] goals. We all The program concluded that medication discrepagree that it’s a good thing to do. There are changes ancies at discharge were “disturbingly” common, that are complex.” but that “a pharmacist-facilitated discharge process Benjamin said ASHP was pleased to see suggested increased recognition and resolution of these errors. revisions included in the 2009 goals concerning drug Follow-up telephone calls both enabled pharmacists reconciliation lists. “Only the most current [medica- to reinforce discharge instructions and promoted tion] list is the most important,” she said. early recognition and resolution of post-discharge Still, she added, medication reconciliation may medication-related problems.” prove the most troublesome for health-system Hospitals are also grappling with the anticoagupharmacists. In the past, medication reconciliation lation requirements. Pennsylvania-based Geisinger has been complex and cumbersome. Inaccurate Health System established a system-wide team to medication lists have caused numerous errors. Ac- review its current anticoagulation processes. It cording to the 2009 NPSGs, a process must exist created a team that included clinical pharmacists, for comparing the patient’s current medications medical staff, and nurses. Dean Parry, R.Ph., direcwith those ordered while under care. When a pa- tor, clinical programs at Geisinger, said the hospital tient is transferred, the complete and reconciled used “numerous resources” to identify risk areas. list of medications must be communicated to the The team’s analysis led to process changes designed next provider. When a patient is discharged, the to reduce risk. Parry said the changes included the complete and reconciled list of medications must be development of a pharmacy-run inpatient anticoprovided to the patient’s primary care provider or agulation management program. DT “The way the goals are stated, they give pharmacists better guidance.” http://www.drugtopics.com

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Drug Topics- August 11, 2008 Contents Latebreakers Letters DEA Proposes Rule To Allow Electronic Prescriptions for Controlled Substances Merger, Medicare Reform Could Mean Broader E-Prescribing Adoption New Combination Pill Approved for Type 2 Diabetes New Eczema Guildlines Promote Use of Emollients, Then Topical Corticosteroids Agencies Flush Original Strategies in Favor of Promoting Drug Take-Back Programs JP at Large: You Laughing at Me? Pharmacists Find Themselves at Mercy of Prior Authorization State Law Requiring PBM Transparency See Some Gains, Some Losses Global Counterfeiting Still Growing, Says U.S. Commerce Official FDA Saftey Page: Prophylthiouracil Still Confused with Purinethol (mercaptopurine) New Products Bring Lice Treatment to a Head NACDS Marketplace Showcases New Product that Fill Unmet Needs Update on Respiratory Tract Infections Execs Share War Stories About Adopting Technology in their Stores New Products Advertisters Index Classified Viewpoint: Medicare Part D Revisions sorely needed

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