The Pharmacist’s News Source
pharmacypracticenews.com
Volume 40 • Number 6 • June 2013
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in this issue UP FRONT
3
Opioid–antidepressant combo plays major role in U.S. drug deaths.
CLINICAL
4 13 26
In cancer, new oral anticoagulants can be tricky. Tips for managing medications in dementia. Pharmacist-driven discharge process boosts drug compliance.
OPERATIONS & MGMT
28
Parkview Health slashes 30-day readmissions.
POLICY
33
FDA reverses itself on abuse deterrence requirement for generic opioids.
38
Are GPOs to blame for drug shortages?
EDUCATIONAL REVIEW
Medication Errors: A Year In Review, Part 2 See insert after page 12.
Closed System Transfer Devices See insert after page 20.
Does HELP Bill Go Far Enough?
Canadian Chemo Dilutions Hint at U.S. Vulnerabilities
A
M
Compounding legislation:
s the Senate Health, Education, Labor, and Pensions (HELP) Committee put the final touches on legislation that would give the FDA new powers to regulate pharmacy compounding, stakeholders issued mixed reviews on whether the bill does enough to ensure patient safety. One major feature of the bill is to exempt hospital pharmacies from regulations that prohibit compounding batches of drugs without patient-specific prescriptions. Although the exemption was applauded by the American Society of Health-System Pharmacists (ASHP), others were not as sanguine. The exemption is “a terrifying part of the legislation,” said Eric Kastango, RPh, MBA, the president and chief executive of Clinical IQ. The bill “will drive more compounding into facilities that don’t have the expertise to ... comply with USP Chapter <797>. It’s only a matter of time before we have a catastrophic event in a hospital because of poor oversight.”
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ore than 1,200 oncology patien nts in five Canadian hospital s received diluted doses of gemcitabinee and cyclophosphamide for a year orr longer because labels on bags of pre-mixed IV drug solutions prepared byy an outsource compounding pharmacyy did not make clear that the bags weree intended for single individuals only. In its May newsletter, the London Health Sciences Centre, where 651 adults and 40 children were said to have received insufficient doses, explained how the mistake went undetected for a year. “It was not known to us that these bags from thee supplier were improperly labeled. It has since been learned that these bags were o overfilled, containing small amounts of extra saline liquid. This meant that the medication con ncentration was lower than [what was] indicated o on the label. The small amount of extra liquid was vvery difficult to see with the naked eye and, becausee several people would withdraw small amounts fro om the bags to prepare individual doses for patients, th his overfill [and dosage dilution] went undetected.”
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see HELP BILL, page 32
In Carboplatin Dosing, Lack of Guidelines Cited Renal function testing a major source of confusion Los Angeles—Many pharmacists are unclear about how they should be dosing carboplatin and would like an organization to come forward and provide standards, according to a panel discussion during the recent annual meeting of the Hematology/Oncology Pharmacy
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see DOSING, page 6
see CAN NADA ERRORS, page 10
Accreditation for Community Pharmacies Get Mixed Reactions
C
ommunity pharmacies will soon face the decision of whether to become accredited by the Center for Pharmacy Practice Accreditation (CPPA), URAC or to forego accreditation—at least for now. Supporters of the push for accreditation claim it will raise the overall quality of the profession, whereas opponents argue it is duplicative of existing state and federal laws, and overly burdensome in terms of cost, time and effort. Last summer, both URAC (formerly known as the Utilization Review Accreditation Commission) and CPPA, the most recent entrant
into the accreditation arena, held public comment periods on proposals to establish accreditation programs for community pharmacies— from independents, chains, and mail-order pharmacies, to outpatient pharmacies associated with health systems and hospitals. More recently, CPPA released consensus-based standards in an attempt to identify pharmacies that are focused on advancing patient care, safety and quality. The nonprofit organization is a partnership between the American Pharmacists Association (APhA), the
FDA Watch
The Book Page
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see ACCREDITATION, page 31
FDA approves Invokana tablets for adults with type 2 diabetes.
Mosby’s Drug Reference for Health Professions
See page 35.
See page 37.
Mosby