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in this issue UP FRONT
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Drug shortage bill passes; a victory for pharmacy advocacy.
TECHNOLOGY
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High-tech tools for enhancing safety of sterile IV compounding. Off-the-shelf clinical decision software is nott a prescription for success.
OPERATIONS & MGM MGMT G T
MEETING HIGHLIGHTS
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Tips for boosting HCAHPS scores. Revamping IV workflow eases drug shortages.
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Fast-tracked nuclide therapy for prostate cancer ‘exceptionally exciting.’
EDUCATIONAL REVIEW
Antimicrobial Stewardship Management of Infections: Beyond the Costs of Antimicrobials See insert after page 44.
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Volum me 39 • Number 8 • August 2012
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40th ANNIVERSARY YEAR 1972–2012
Building a Better CPOE System Via MEDMARX Data
Smart Pumps Get Better Grades After QI Initiatives
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Revamping drug libraries at heart of the quality improvement efforts
physician–pharmacist research team at Brigham and Women’s Hospital, in Boston, has data-mined a decade’s worth of computerized prescriber order entry (CPOE) system error reports. Their findings—reported at an informatics meeting last year and now bolstered by more recent data—have shed new light on the types of errors that sometimes plague this medication safety technology. Pull-down menu mishaps, interoperability snafus and incorrect dosing instructions are just a few of the common errors the researchers uncovered, according to Gordon Schiff, MD, the associate director of the Center for Patient Safety Research and Practice at Brigham and Women’s Hospital, and the study’s principal investigator. The results offer current CPOE users a roadmap for improving their own systems, with an important added benefit: “We’ve gained the ability to create and test a new taxonomy for understanding CPOE-related errors,”
Baltimore—A five-year quality improvement effort at a California children’s hospital aimed at revamping the facility’s “smart” programmable infusion pump drug libraries has significantly bolstered the technology’s impact on patient safety. A 40% reduction in potentially severe adverse drug events, a nearly 50% reduction in nonclinically significant alerts and a doubling of drug library usage are among the improved outcomes documented, according to Katie Tu, PharmD, a pharmacy educator at Children’s Hospital of Orange County (CHOC), in Calif. The efforts have resulted in millions of dollars in avoided costs annually, Dr. Tu noted during a poster presentation at the American Society of Health-System Pharmacists (ASHP) 2012 Summer Meeting.
see CPOE, page 9
see SMART PUMPS, page 12
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‘Good Results’ program slashes HIV adverse drug events.
HEM/ONC PHARMACY
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Carfilzomib Gets Approved for MM: Practice Changer?
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n late July, the FDA approved carfilzomib as a monotherapy for patients with relapsed and refractory multiple myeloma. Interviews with several hematology/oncology experts suggest that the drug will have a significant impact on the treatment of this challenging malignancy. Onyx Pharmaceuticals, which will market the drug as Kyprolis, had asked that carfilzomib be approved for patients with multiple myeloma
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see CARFILZOMIB, page 40
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Milk-thistle Extract Takes the Sting Out of Amanita Mushroom Toxicity San Diego—Silibinin, a constituent of milk thistle ((Silybum marianum), can help reverse the effects of severre mushroom poisoning, accord-ing to a case series present-ed at Digestive Disease Weeek (abstract Su1606). In the case series, four patients ate mushrooms of the genu us Amanita, which the researchers said is responsible for more than 9 90% of fatal mushroom poisonings in n the United States. All four patieents recovered, further bolstering evi-
dence of the efficacy of the investigational agent, which has been used successfully in more tthan 40 patients to date. Thee four patients presented over a two-week period at Medstar Georgetown University Hospital, in Washington, D.C., with acute hepatitis caused by acute mushroom poisoning. One patient had concurrent pancreatitis. The patients received aggrressive hydration, IV silibinin infussion (Legalon SIL, Madaus),
The Book Page Best Practices for Hospital and Health-System Pharmacy 2011-2012 American Society of Health-System Pharmacists See page 43.
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see POISONING, page 37
New Product Cooper Atkins introduces new temperature data loggers. See page 42.
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