Publication Date 01/07/2014         Volume. 6 No. 6   
Information to Pharmacists

Editorial

From the desk of the editor

Welcome to the July 2014 homepage edition of i2P (Information to Pharmacists) E-Magazine.
At the commencement of 2014 i2P focused on the need for the entire profession of pharmacy and its associated industry supports to undergo a renewal and regeneration.
We are now half-way through this year and it is quite apparent that pharmacy leaders do not yet have a cohesive and clear sense of direction.
Maybe the new initiative by Woolworths to deliver clinical service through young pharmacists and nurses may sharpen their focus.
If not, community pharmacy can look forward to losing a substantial and profitable market share of the clinical services market.
Who would you blame when that happens?
But I have to admit there is some effort, even though the results are but meagre.
In this edition of i2P we focus on the need for research about community pharmacy, the lack of activity from practicing pharmacists and when some research is delivered, a disconnect appears in its interpretation and implementation.

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Physicians Need Bar Coding Too

Mark Neuenschwander

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Mark Neuenschwander has earned his reputation as one of the nations' leading authorities on dispensing and point of administration automation. Whether writing, lecturing or problem solving with a client, Mark communicates in terms and concepts that are easy to grasp and apply. His fresh perspective and keen insight stem from having invested thousands of hours in research and in-depth consulting with clients.

I’ve been thinking about Car Talk, prayer, clinical documentation, and diagnostic errors.
What’s a Saturday morning without Car Talk?
After 30 years, I still enjoy eavesdropping on Tom and Ray Magliozzi taking calls from listeners about their automobiles’ ailments.
Between outbursts of laughter, the bantering brothers diagnose, prescribe, offer second opinions, and, with limited information, have to guess a lot.

This week, the Tappet Brothers gave a $26 gift certificate to the winner of their weekly puzzler—“The exact price,” said Ray, “of kid’s T-shirts available at cartalk.com’s Shameless Commerce store, which say, ‘Help! My parents make me listen to Car Talk.’” Sign of a good parent, in my opinion.

Sad to say, these shirts weren’t available when we were schlepping the kids to Saturday soccer. Happy to say, however, my children have matured to the point of making their children listen to Click and Clack on Saturday mornings.

Last week, Ray and Tom, whose radio show emanates from Harvard Square, read through a list of course evaluations written by students at their nearby alma mater, MIT. My favorite was, "The course was very thorough. What wasn't covered in class was covered on the final exam." Reminds me of a student who trumped a debate over prayer in schools by suggesting, “As long as we have exams, there will be prayer in schools.”

Students who sporadically attend lectures shouldn’t be surprised when they must resort to asking for miracles during finals. But what’s a student to do if she doesn’t play hooky, daydream in class, or snooze through lectures only to confront an exam that requires information the professor failed to cover?

Now, drive across the bridge and down the St. Charles from MIT to Brigham and Women’s Hospital (BWH). What are their docs to do when diagnosing patients whose medical records contain incomplete or errant documentation? Do they even have a way of knowing anything is wrong? In any instance, no physician is smart enough, no computerized physician-order entry (CPOE) system is robust enough, and no prayer is sincere enough to create missing or heal inaccurate documentation.

In case you haven’t read my previous Thinking on the value of bar-code medication administration (BCMA) to physicians, let me summarize. First, the obvious and most touted benefit of BCMA is ensuring the drugs doctors order are given to the right patients as ordered. Of equal or possibly greater value is BCMA’s lesser-understood role in improving the accuracy of documentation on which physicians must rely when diagnosing patients.

Want a second opinion?

Toronto physicians, David Cescon and Edward Etchells (more from them below), said it simply: “BCMA automatically generates an accurate electronic medication administration record, improving both patient care and hospital invoicing,” to which I would add “physicians’ diagnosis.”

There are a couple safety-talk guys in Boston whose opinions we all take even more seriously than the Car Talk guys. In a recent New England Journal of Medicine (NEJM) Perspectives” column, Gordon Schiff and David Bates state the obvious and then surprise us. "A fundamental part of delivering good medical care is getting the diagnosis right. Unfortunately, diagnostic errors are common, outnumbering medication and surgical errors as causes of outpatient malpractice claims and settlements.”

Their “think piece,” as Gordon called it in an e-mail exchange I had with him, addresses the question, “Can Electronic Clinical Documentation Help Prevent Diagnostic Errors?” They answer with an opinion: “EHRs [ed. electronic-health records] promise multiple benefits, but we believe that one key selling point is their potential for preventing, minimizing, or mitigating diagnostic errors." Though it was not the focus of their article, I would suggest this is as true for the electronic medication administration record (eMAR) and CPOE as any other clinical documentation piece in the EHR universe.

Beyond think and opinion, in their landmark study published in NEJM entitled, “Effect of Bar-Code Technology on the Safety of Medication Administration,” researchers at the Brigham (including Dr. Bates) identified an “80.3 percent reduction in administration documentation errors with bar-code technology, along with significant reductions in potential adverse drug events associated with administration documentation errors.”

“Our study,” they report, “suggests that the prevention of many of the potential adverse drug events could be attributed to the reduction in documentation errors. This finding may lead some to conclude that the eMAR component of the bar-code eMAR may have greater effect than the medication-verification component.”

A couple of Boston beans tossing up car advice based on half the story is fun—a great way for passing time. Students taking exams based on incomplete lectures isn’t fair. It could be the difference between passing and failing. Physicians diagnosing patients with incomplete or inaccurate documentation isn’t right. It could lead to their patients prematurely passing on. I’m not opposed to prayer in hospitals, but there’s no substitute for accurate documentation.

In their excellent JAMA “Commentary” entitled, “Barcoded Medication Administration—A Last Line of Defense,” Cescon and Etchells don’t mince words: “The healthcare system must wait no longer to provide them and all patients, with the systematic safety net that they deserve.” I realize that the “them” they refer to is nurses, but I’d argue that their BCMA “safety net” is just as important for doctors who want to diagnose accurately.

What do you think?

Mark

Mark Neuenschwander a.k.a. Noosh

BTW. I’ve met some nurses, who at the beginning of BCMA implementations might have been willing to wear T-shirts that read, “Help! My hospital makes me use bar coding at the point of care” (sign of a good hospital, in my opinion), who eventually became more enthusiastic about the technology than I am about Car Talk.

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