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pharmacypracticenews.com
The Pharmacist’s News Source Hematology/Oncology Pharmacy Edition
Volume 38 • Number 6 • June 2011
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Part 1 of a two-part series
Tainted TPN Cases Put Focus on <797> Rules
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hree years after the U.S. Pharmacopeia (USP) issued a major revision to General Chapter <797> concerning pharmaceutical compounding of sterile preparations, questions and concerns continue to be raised about proper procedures to clean and disinfect equipment, sample and monitor air and surfaces, and train and evaluate personnel. Many of the concerns stem from several wellpublicized incidents of patient infections and deaths tied to contaminated products prepared at compounding pharmacies. Most recently, in March, nine patients at six Alabama hospitals died from Serratia marcescens-associated infections from contaminated total parenteral nutrition (TPN) admixtures prepared at one pharmacy. According to the Alabama Department of Public Health, the source of the bacteria was traced to Meds IV, an outsource compounding
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see TAINTED TPN, page 7
Can Patients, Caregivers Shoulder the Rising Cost of Cancer Therapy?
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hanks to improving survival, changing practice patterns and an aging and growing population, the total cost of cancer care in the United States may surpass $200 billion by 2020, according to new projections from the National Cancer Institute (NCI; JNCI J Natl Cancer Inst 2011;103:117-128). That is 66% higher than total cancer care costs today. “There is a continuing ratcheting up of what is a socially acceptable price for chemotherapy,” said David H. Howard, PhD, associate professor of health policy and management at Emory University in Atlanta. “Every few months, another new treatment comes out with an eye-popping price,” added Dr. Howard, who was not involved in the NCI study. “Many of these drugs do increase survival time but it’s
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see NCI REPORT, page 17
in this issue Policy
Quality Improvement Accountable care organization initiatives gain momentum.
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ASHP House of Delegates vote may yield more direction
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Technology
Bar Coding The clinical and business case for BCMA.
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Operations & Mgmt
Drug Costs Helping patients benefit from pharmaceutical assistance programs.
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Leadership in Action Listening: the first step on road to success.
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Clinical
Practice Pearl Dietary supplements: a teaching opportunity for pharmacists.
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Hem/Onc Pharmacy When drugs are dispensed from oncology offices, do patients benefit?
Pharmacists’ Role in Medical Marijuana Remains a Bit Hazy
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Is it ever safe to stop premedicating paclitaxel patients?
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Educational Reviews
Managing Anemia in CKD Patients Insert after page
Evolving Treatment Paradigms In NSCLC Insert after page
s more states legalize marijuana, pharmacists and other clinicians are left somewhat stranded on the front lines, trying to navigate a path between conflicting legal requirements and effectively treating their patients. Fifteen states and the District of Columbia have approved medical usage of marijuana and at least a dozen more are considering various stages of legislation, according to the Marijuana Policy Project, a Washington, D.C.-based lobbying organization. Meanwhile, pharmacists say they are facing more questions than answers. Among their concerns: what to do if a hospital patient brings in marijuana; what about medication reconciliation and potential clinical interactions; and how to verify the safety of the product itself. “In some ways this is an instance where the legality has gotten ahead of how we know how to use it,” said Cynthia Reilly, RPh, director of the Practice Development Division at the American Society of Health-System Pharmacists (ASHP). “There are so many unknowns, but clinicians are being faced with patients who are using it.” This month, ASHP’s House of Delegates is scheduled to vote on a medical marijuana policy during the group’s Summer Meeting. The policy was developed in
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New Reporting Tool May Provide Better Measure of Hospital Safety
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see MARIJUANA, page 9
he standard methods for detecting adverse events in hospitalized patients could be underreporting the true incidence of such episodes by a factor of 10, a new study has found. Hospitals typically use either voluntary reporting systems or patient safety indicators designed by the Agency for Healthcare Research and
Quality. But the new study showed that these two measures detect only 1% and 9% of adverse events, respectively. In contrast, a relatively new technique, called the Global Trigger Tool, identified 90% of adverse events, according to the researchers. Developed in 2003 by the Institute for Healthcare Improvement (IHI), a
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see REPORTING TOOL, page 36
New Products American Health Packaging launches three new unit-dose products, including Donepezil 5 and 10 mg tablets.
FIRST® “Magic Mouthwash” Compounding Kits from Cutis Pharma. See page
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