August 2013

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The Pharmacist’s News Source

pharmacypracticenews.com

Volum me 40 • Number 8 • August 2013

Printer-friendly versions available online

in this issue UP FRONT

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MRI detects spinal infections from contaminated NECC steroids

POLICY

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FAQs on outsourcing versus insourcing of sterile products 340B: Get ready for audits and possible legislative changes

CLINICAL

MEETING HIGHLIGHTS

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Making treatment decisions for patients with antibiotic hypersensitivity

55

IVIG FAQ: dosing considerations in obese patients.

Pharmacists Feeling Pain Over AMA Resolution

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Physician group blasts profession’s ‘intrusion into medicall practice’

he American College of Physicians (ACP) has advised clinicians not to use intensive insulin therapy (IIT) to manage hyperglycemia in surgical and medical intensive care unit (SICU and MICU) patients with or without diabetes. The ACP concluded that targeting blood glucose levels between 80 and 100 mg/dL does not lower the risk for ICU-related mortality and increases the risk for hypoglycemia by more than five times. Amir Qaseem, MD, PhD, MHA, the director of the ACP’s Department of Clinical Policy and lead author of the ACP report ((Am J Med Qual 2013 May 23. [Epub ahead of print]), said he is “very confident” in the recommendation that clinicians use blood glucose targets of 140 to 200 mg/dL in these ICU populations. “Although many hospitals and health care systems developed protocols to implement IIT routinely in critically ill patients,

OPERATIONS & MGMT

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Tight Control Of ICU Glucose Takes a Big Hit

In this month’s Leadership in Action column, Ernest Anderson Jr., asks, ‘Are you really in charge?’

EDUCATIONAL REVIEW

The Future of Antibiotics: Preserving A Precious Commodity See page 38.

see ICU GLUCOSE, page 52

Casting a Wider Safety Net For Elderly Patients Minneapolis—The Pharmacological Intervention in Late Life (PILL) Service, an innovative elderly care outreach program developed by the Veterans Administration Boston Healthcare System (VABHS), has reduced 60-day hospital readmissions and improved a host of other clinical outcomes. The PILL Service has shown its economic worth as well: In 2012, the

see PILL SERVICE, page 48

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bluntly worded American Medical M Association (AMA) resolutio on that was intended to curb a barragge of retail pharmacy phone calls to p physicians requesting additional infformation about pain medication prrescriptions has triggered a backlaash from pharmacists, some of who om objected to the resolution’s shaarp tone as a departure from the mo ostly collegial relationships that exist between the two professions. “It’s a step backward,” said David D Craig, PharmD, BCPS, a clinicaal pharmacy specialist at the H. Leee Moffitt Cancer Center and Research h Institute, in Tampa, Fla. “I work collabo oratively witth many physicians who do not agrree with this reso lution at all. In fact, they welccome any pharrmaacccis ist’ ts input, advice and recommendattions.” The policy passed by the AM MA House of Delegates in June was written in reesponse to what th the he

see AMA RESOLUTION, page 116 6

Big Ideas for Boosting Drug Safety Minneapolis—The 2013 Summer Meeting of the American Society of Health-System Pharmacists, a smaller version of the mammoth Midyear Meeting held each fall, included some big ideas nevertheless. Here, we cover several noteworthy posters dealing with diverse aspects of medication safety.

Insulin Is Unrecognized Source of Errors Only after it installed an automated adverse drug event (ADE) surveillance system did BJC Healthcare—a 13-hospital system in the St. Louis region—realize that 75% of all ADEs occurring throughout its network resulted from insulin-related severe hypoglycemia.

FDA Watch

“Severe hypoglycemia wasn’t on anybody’s radar,” said Paul Milligan, PharmD, the senior clinical lead at BJC Learning Institute’s Center for Clinical Excellence. The new system also was used to document the underlying causes of harm and generated monthly hospital-specific reports. And it pinpointed, by hospital (even down to the unit level), where the harm occurred. Previous ADE surveillance relied on self-reporting or random sampling, as many health systems still do. That process, Dr. Milligan noted, was arduous, time-consuming and could be misleading because information about the underlying

see BIG IDEAS, page 46

The Book Page

Telavancin receives nosocomial pneumonia indication.

Handbook on Injectable Drugs: 17th Edition

See page 54.

See page 57.

Lawrence A. Trissel, FASHP

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