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Volume 40 • Number 12 • December 2013
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in this issue UP FRONT
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VTE, an underrecognized risk for chemotherapy patients.
POLICY
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At Fall HOPA meeting, a plan for boosting hospital reimbursement.
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2014 OPPS payment rules begin to take shape; here’s what to expect.
CLINICAL
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Choosing the best local anesthetic for peripheral catheter placement.
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Do financial penalties for medical errors have any place in a just culture of safety?
As Compounding Law Passes, Split Views Persist
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he Drug Quality and Security Act, which aims to close holes in the regulation of compounding pharmacies, was recently voted into law. Both the House of Representatives and the Senate passed the bill by a voice vote. Speaking from the Senate floor on Nov. 12, Sen. Harry Reid (D-Nev.) called the bill “a matter of life and death,” referring to 2012’s deadly outbreak of fungal meningitis traced back to the New England Compounding Center. But outside of Washington, support for the new law is mixed. In a statement on Sept. 28, David G. Miller, RPh, chief executive officer of the International Academy of Compounding Pharmacists (IACP), said the bill “does not contain any provisions that speak directly to standards aimed at raising the quality of compounded medications.” The legislation “will not protect the American public” and “contains significant gaps,” the trade group added.
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Is It Time To Cap Chemo Rx In Advanced Lung Cancer? Boston—A year ago, Leigh Boehmer, P PharmD, a clinical pharmacist at Barnes-Jewish Hospital in St. Louis, saw a patient with metastatic no on-small cell lung cancer (NSCLC) who had co omplete hearing loss in his right ear, acute kidneey injury and a serum sodium level of 114. Despite tthese clear signs of chemotoxicity, Dr. Boehmer wass astounded to find that the man had received 16 cyccles of cisplatin-paclitaxel. And yet the firsst question asked by the patient, despite hiss overly aggressive therapy, was, “When do o I get cycle number 17? It is due today.” At the recent Oncology Pharmacy Educcation Network meeting, Dr. Boehmer and a other pharmacists discussed the difficultty of deciding when to limit chemotherap py duration for stage IV lung cancer. Firsttline, second-line and even later cycles o of therapy, as well as palliative therapy, havve played a role in such patients, but questio ons abound regarding how long therapy sho ould be given and whether the benefits are worth w the risks, with respect to both quality of o life (QoL) and cost. Clinicians need to thin nk about the benefits and costs of a given cheemotherapy regimen, and how those factors might afffect a patient,
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see COMPOUNDING, page 9
se ee LUNG CANCER, page 11
OPERATIONS & MGMT
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FDA strengthens its ability to forestall drug shortages. Pharmacy leaders: Are you ‘ridiculously in charge’? Here’s how to tell.
EDUCATIONAL REVIEW
Pain, Sedation, and Delirium in the ICU: The Pharmacist’s Role See insert after page 18.
Into the Cloud For Enhanced Drug Adherence
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loud-based computing has come to health systems, and it promises to be a powerful tool in the fight against medication nonadherence—a persistent problem that continues to boost 30-day hospital readmissions and trigger potentially steep payment penalties. MCS Carelink, a Danvers, Mass.based company, has developed a new service that uses algorithmic analyses
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see INTO THE CLOUD, page 32
For Safer Smart Pumps, Setting Harder Drug Dose Limits Urged
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wo health systems have revamped their procedures for establishing safe drug dosing ranges in “smart” IV infusion pumps and communicating the new ranges to key personnel on the care team. By doing so, the hospitals have eliminated at least one potentially dangerous dispensing habit—dosing heparin at a rate up to 45 times higher than its recommended upper soft limit. The primary fix was to add hard limits for the anticoagulant into the drug library. “The overall goal is to improve safety and reduce errors during the IV administration process
by making it difficult for users to do the wrong thing,” Cleveland Clinic pharmacist Silvana Balliu, PharmD, said during a Web conference hosted by the Institute for Safe Medication Practices (ISMP). “The only way to do this is [via] hard limits.” The need for more stringent programmed dosing guidelines at the Cleveland Clinic came to light when Dr. Balliu and her colleagues reviewed their smart pump data. They found that to administer boluses of heparin from the IV bag, clinicians had
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see SMARTER PUMPS, page 34
Special Feature
The Year in Pharmacy Highlights of top stories in 2013 see page 28