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#5
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The Pharmacist’s News Source
pharmacypracticenews.com
Vollume 40 • Number 5 • May 2013
Printer-friendly versions available online
in this issue UP FRONT
4
White-bagging column has some readers seeing red.
OPERATIONS & MGMT
10
When drugs become scarce, OhioHealth’s rapid response team answers the call.
CLINICAL
17
Preventing rare but deadly lithium toxicity, other clinical pearls.
TECHNOLOGY
24 29
A tale of two IV prep robots. A trio of high-tech pharmacy successes.
POLICY
36
FDA official: agency needs more weapons in fight against unsafe compounders.
EDUCATIONAL REVIEW
Pathogenesis Of a Hereditary Predisposition To Breast Cancer See insert after page 16.
Corporate Spotlight Medi-Dose/EPS see page 15
APP see page 39
FDA Inspections Taking a Toll On Compounders
A Dangerous Interplay: Rx Shortages and Med Errors D
barrage of inspections by FDA and state pharmacy board investigators has uncovered numerous safety violations at compounding pharmacies that supply hospitals and practitioners across the country with batch quantities of customized sterile solutions. Most of the investigators’ on-site reports have focused on incidents of failure to maintain optimal-quality conditions and procedures for safe sterile compounding, a reflection of lax adherence to U.S. Pharmacopeia Chapter <797> standards. But some inspections also have uncovered evidence of product contamination, and several recent highly publicized cases have led to large-scale product recalls. On April 17, for example, Balanced Solutions Compounding Pharmacy, of Lake Mary, Fla., initiated a total sterile products recall “due to concerns associated with quality control processes” that led to “a lack of sterility
uring two months starting in November 2010, more than 200 patients at seven hospitals in the MedStar Health system in the Maryland and Washington, D.C., region received double their prescribed concentration of potassium acetate. In response to a shortage of the usual stock dose of the drug (2 mEq/mL), MedStar acted to fill the gap by procuring vials containing a 4-mEq/mL solution. The wrong concentration was entered into the An image of a TPN room IV compounder software, with drug error investigators. which then identified the new vials as containing the lower dose, and the drug was administered to patients receiving total parenteral nutrition. No patients experienced injuries or medical abnormalities, which is one reason why the mistake went undetected for so long. That the error occurred is disturbing, but unfortunately no longer surprising in a time when medication errors are rampant. Yet something does set this event apart other than its scope and duration—the fact that MedStar chose to shine a light on the event and allow
see COMPOUNDERS, page 34
see INTERPLAY, Y page 8
A
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Help Wanted, Onc Pharmacist? Getting the OK Los Angeles—Does your hospital need a new oncology pharmacist? At the annual meeting of the Hematology/Oncology Pharmacy Association, attendees were given ammunition— such as the potential for millions of dollars in annual savings and revenue—they can use to convince administration of the benefits that accrue when such a specialist is added to the patient-care team.
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see HELP WANTED, page 20
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Goading and Gaming Can Help Increase Medication Adherence San Diego—The staggering $317 billion that medication nonadherence costs our health care system each year can be chipped away at if pharmacists encourage proper medication use, an expert told attendees of the Academy of Managed Care Pharmacy’s (AMCP) 25th Annual Meeting and Expo. “None of the medicines we develop, none of our efforts to make sure these medicines are accessible to patients, none of the guidelines we create, none of these matter if we don’t actually get the medicine into a patient’s body,” said Yelena Yankovskaya,
PharmD, a fellow in managed markets at Mayes College of Healthcare Business and Policy at the University of the Sciences, in Philadelphia. “As pharmacists, I think we have a great opportunity to save lots of money both for our patients and ourselves if we improve adherence.” The financial toll of nonadherence is striking: $317 billion in health care expenditures are attributable to preventable disease-related complications, Dr. Yankovskaya said, referring to data from Express
New Product
Special Report
•
see ADHERENCE, page 22
Fresenius Kabi USA introduces new Heparin Labels
Understanding Key Differences Between Biosimilars and Small Molecule Generics
See page 23.
See insert after page 24.
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