See ADVER RTISERS IND DEX polybagged with h this issue e
The Best-Read Pharmacist’s News Source
pharmacypracticenews.com
The power—and peril—of protein in the ICU ..........................
10
An urban medical center tackles the opioid crisis .....................
21
OPERATIONS & MGMT
Ambulatory pharmacists provide value during COVID-19 ......................... 26
30
POLICY
Talking turkey about reimbursement .............
32
Amid COVID-19, challenge of DIY 503B continues ............
34
TECHNOLOGY
CSTDs: Tips for product selection and review ......................
38
SPECIALTY PHARMACY
A $500K windfall from biosimilars ...........
42
REVIEW ARTICLE
Biosimilars in Oncology The Role of Pharmacists In Education: Part 3 of 3 See page 18.
Overworked staff, lax medication handling among risk factors seen
CLINICAL
Outpatient antibiotic stewardship spreads its wings ...........................
Volume 47 • Number 11 • November 2020
‘Pandemic Nursing’ Is a Lethal Problem; ISMP Cites ‘Blame and Shame’ Culture A
dd “pandemic nursing” to the list of COVID-19 threats to medication safety. The practice pressure has led to at least one lethal drug error in a hospital scrambling to cope with a surge in cases, according to a new report from the Institute for Safe Medication Practices (ISMP). The ISMP’s Medication Safety Alert included details about a nurse working at a hospital where the death occurred. “The nurse works in a busy ICU treating about 20 COVID-19 patients daily, most of whom have multiple high-alert medication infusions (e.g., fentaNYL, propofol, norepinephrine, cisatracurium) administered via smart infusion pumps located inside their rooms,” the newsletter reported.
Accreditors Ease Off Rules Amid COVID-19
L
eading accreditation bodies for specialty pharmacy have modified their procedures and requirements for initial accreditation and ongoing reporting in response to the COVID-19 pandemic, according to presentations at the National Association of Specialty Pharmacy 2020 Annual Meeting & Expo. “Something we’ve become fond of saying is ‘normal processes are for normal times,’” said Jon Pritchett, PharmD, a program director at the Accreditation Commission for Health Care (ACHC). “At the end Continued on page 42
The care provider described an under-resourced environment, high patient-to-nurse ratios, and stashes of medication infusions left in patients’ drawers and closets—an aggregation of risk factors that led to wrong-concentration and titration errors, including Continued on page 6
Automated Dose Rounding Yields $3.6 Million in Savings I ntegrating an automatic dose-rounding policy into an electronic health record (EHR) system can lead to millions in cost savings on oncology infusions, according to an abstract presented at the Hematology/ Oncology Pharmacy Association (HOPA) 2020 virtual conference. Researchers at Michigan Medicine developed a system that automatically rounded doses that were within 10% of the nearest vial size when physicians placed electronic orders for infusions of monoclonal antibodies and cytotoxic agents. Over one year, the system led to approximately $3.6 million in savings on two dozen high-cost oncology medications. Now, the system has become
Special Focus:
COVID-19 Pandemic More coverage on pages 4, 12, 14, 26, 34, 38, 40.
routine at Michigan Medicine, according to the study authors. “Like all organizations that treat cancer patients, we continue to see the cost of cancer drugs increase over time,” said Shannon Hough, PharmD, BCOP, the pharmacy manager of oncology clinical programs at Michigan Medicine, in Ann Arbor, and a co-author on the study. The average FDA-approved therapy is significantly more expensive now than it was 10 years ago, she said. “So, anytime we have the opportunity to modulate some of those costs, both for us and for our patients, we’d like to work on those things.” Continued on page 39
