Greetings VtSHP Members,

I want to invite you all to mark your calendar for our annual CE and Spa Day at the Stoweflake Resort on Feb. 7th, 2009. This year we will be providing 2 ACPE credits for our program on Asthma Update. Our speaker is Gary Milavetz, Pharm D, FCCP, Associate Professor of Pharmacy, from the University of Iowa. Gary will review the latest NIH guidelines for the diagnosis and management of asthma for the first hour. The second hour will focus on respiratory medication delivery including the appropriate use and education of patients using metered-dose inhalers, dry powder inhalers, and valved holding chambers. This will include a hands-on workshop with these devices.

Of course, during the presentation, you will be able to partake in a delicious breakfast/brunch with plenty of wonderful food. And then, to work off the great breakfast, you can either spend the day skiing, or use the spa facilities at the resort. As a participant in the meeting, you will have free use of the great exercise facilities (several exercise machines, including exercise bikes, treadmills, and elliptical machines). Then, it will be time to relax at the spa. The Stoweflake Resort spa features the Bingham Hydrotherapy Waterfalls, a 12 foot cascading therapeutic falls, and the Hungarian Mineral Soaking Pool, featuring mineral salts from Hungary. Or you can always make an appointment for a massage or other special spa treatment. Visit the website “stoweflake.com” for more information on the spa facilities.

Look for further details in our upcoming meeting announcement.

Also, mark your calendars for our annual day-long meeting on April 4th, 2009. We have several great speakers lined up.

Hope to see you at one of these events!!!!

Clare Coppock, RPh
President-VtSHP
ccoppock@rrmc.org
802-772-2469

Dear Colleagues:

As I write this, I am at ASHP headquarters in Bethesda, Md., for the ASHP Board of Directors meeting. It’s great to be just outside Washington, D.C., as the city prepares for the presidential inauguration! The city is full of energy and excitement as the final preparations are made.

That excitement is easy to catch! While there are clearly many difficult challenges that lay ahead for our nation, there is also great opportunity for pharmacists. It was extremely inspiring to hear the Department of Health and Human Services Secretary-Designate Tom Daschle, during his Senate confirmation hearing, point to the expanded role that pharmacists should play in patient care (read more about that in the article below).

Now it’s up to all of us to step up to the plate to make it happen. Help your ASHP state affiliate reach out to your elected officials at the state and federal level. You can follow the action – and be a part of it – by keeping up-to-date at www.ashp.org/advocacy.

Regards,
Kevin J. Colgan, M.A., FASHP
ASHP President

Sal Morana and Kevin Marvin have been chosen to be the VT delegates to the ASHP Summer Meeting in June 2009. Carl Possidente will be an alternate delegate.

President-elect Obama's nominee for Secretary of the Department of Health and Human Services (DHHS), Tom Daschle, suggested yesterday that pharmacists can play an important role in providing access to health care.

During his Senate confirmation hearing yesterday, DHHS Secretary-Designate Daschle noted that "pharmacists can play a far more important role than they do [in primary care]. That to me is a very important part."

In response to a question during his confirmation hearing, the former Senate Majority Leader (D-S.D.) noted that pharmacists and other health care practitioners can be used far more effectively than they currently are, especially in rural areas. Secretary-designate Daschle was joined by Sen. Tim Johnson (D-SD) at the hearing chaired by Sen. Ted Kennedy. Sen. Johnson has been a key supporter of health-system pharmacy and will provide important input to the new DHHS Secretary.

In his opening statement, Sen. Daschle noted that any health care reform plan must achieve the goals of increasing access and quality while containing cost. This is in alignment with ASHP’s Principles for Health Care Reform . Those principles together with similar ones endorsed by a number of pharmacy organizations were shared with members of the Obama transition team.

ASHP applauds Senator Daschle's recognition and support for the vital roles that pharmacists can play in providing primary care, preventive care, improving continuity of care, and lowering cost, and is poised to help show how pharmacists can help address these broad issues that impact every American

Novant Health in Winston-Salem, North Carolina, is the 2008 winner of the ASHP Foundation's Award for Excellence in Medication-Use Safety. Novant was recognized during the ASHP 2008 Midyear Clinical Meeting, as were the finalists, Northwestern Memorial Hospital in Chicago and Richard M. Ross Heart Hospital, The Ohio State University Medical Center, Columbus. The award honors a pharmacist-led multidisciplinary team for its significant institution-wide system improvements relating to medication use.

A consensus statement recently published in the January 1, 2009 , issue of the American Journal of Health-System Pharmacy (AJHP), sheds new light on the appropriate use and monitoring of vancomycin in adult patients.

Vancomycin is one of the most-widely used antibiotics for the treatment of serious gram-positive infections involving methicillin-resistant Staphylococcus aureus ( MRSA ). The practice of routine monitoring and adjusting of drug dosages based on serum vancomycin concentrations has been the subject of intense debate for many years.

The statement is the result of a consensus review conducted by member experts from the American Society of Health-System Pharmacists (ASHP), the Infectious Diseases Society of America, and the Society of Infectious Diseases Pharmacists. The panel evaluated the scientific data and controversies associated with serum vancomycin monitoring.

The document offers recommendations based on the scientific evidence, including selection of pharmacokinetic and pharmacodynamic monitoring parameters, dosing strategies, methods for monitoring effectiveness, and strategies for preventing toxicity.

Because of concerns about antibiotic resistance, the statement’s advice on dosing to achieve effective drug levels is particularly important, including the recommendation that dosages should be calculated on the patient’s actual body weight.

Participating on the expert panel were: Michael Rybak, Pharm.D., MPH (Chair); Ben Lomaestro, Pharm.D.; John C. Rotschafer, Pharm.D.; Robert C. Moellering Jr., M.D.; William Craig, M.D.; Marianne Billeter, Pharm.D.; Joseph R. Dalovisio, M.D.; and Donald P. Levine, M.D.

Computerized physician order entry (CPOE) systems can eliminate errors related to illegible handwriting or confusing voice messages. Many CPOE systems also offer decision support functions that guide physicians to the correct decision and display warnings about drugs and procedures that could harm patients. Despite the benefits, only around 8 percent of U.S. hospitals have implemented CPOE systems. Leapfrog Group's CPOE Evaluation Tool was recently used by approximately 100 hospitals to test the effectiveness of their systems. The results were disappointing, as some hospitals' systems failed to prevent potentially fatal medication orders and did not catch all drug allergies in simulations. One major problem with CPOE systems is the number of alerts displayed for physicians, many of whom begin to ignore those alerts. To reduce the number of alerts, some healthcare facilities have instead focused on alerting doctors about the medications that have the greatest potential for fatal errors. Staff buy-in for CPOE systems is necessary, which is why many hospitals will phase in electronic ordering over a one year period. Moreover, input from physicians, nurses and pharmacy staff will make full adoption easier. Experts also point out that CPOE adoption will require mandatory training of all staff to ensure the system is used properly.

According to a survey jointly conducted by the Infectious Diseases Society of America (IDSA), Premier and the Society for Healthcare Epidemiology of America (SHEA), some hospitals still have not developed guidelines for programs that manage the use of antibiotics. The Joint Commission has identified improper use of antibiotic treatment as a major barrier to quality improvement and hospital delivery system design. The survey revealed that a majority of the 357 respondents, mostly physicians, said their hospitals did not have established anti-microbial stewardship programs but followed practices similar to IDSA and SHEA protocols. Kimberly Lee, a pharmacotherapy specialist at the Virginia Commonwealth University Medical Center, recognizes that hospitals must take the time and resources to turn anti-microbial stewardship guidelines into effective operational programs. Fifty-five percent of survey respondents cited personnel shortages as the greatest obstacle to implementing effective stewardship programs; financial considerations and other clinical initiatives were also cited as barriers.

Medical malpractice lawsuits involving hospital-acquired infections are on the rise, and several already have resulted in multimillion-dollar awards. St. Louis attorney Mary Coffey of Coffey Nichols says, "A lot of lawyers think they can't ever trace an infection and that getting an infection in a hospital is not necessarily negligent, which is true. But I would say you can prove it." Coffey recently represented a 69-year-old man who contracted methicillin-resistant Staphylococcus aureus through an IV inserted in the ambulance after he had a heart attack. The case resulted in a $2.58 million verdict, with Coffey providing evidence of an infection in the patient's IV site. She showed that healthcare providers failed to heed guidelines from the U.S. Centers for Disease Control and Prevention stating that ambulance IVs should be replaced when the patient arrives at the hospital and that surgeons should not perform heart surgery on patients with remote site infections. Committee to Reduce Infection Deaths Chair Betsy McCaughy says hospitals can reduce litigation risks by instituting strategies to prevent hospital-acquired infections, using an antibiotic-treated backup catheter to guard against central line infections, for instance.

Florida's Flager Hospital recently incorporated IntelliFlow software, a technology solution that tracks the work of pharmacy technicians. A number of high profile heparin overdoses has increased the focus on medication errors made by hospital pharmacies. Errors are usually the result of system and process problems, and even if there is only a 1 percent error rate, there will be several errors made each day at each facility. The IntelliFlow technology uses cameras and foot pedal shutters to take digital pictures in IV rooms, and these images can be checked remotely by hospital pharmacists and medical staff. Although the initial training was not time consuming, many technicians required follow-up training because they struggled taking optimal pictures. Even though the process initially caused technicians to spend more time doing each task, staff members eventually returned to the same level of efficiency. The system tracks every dose prepared in the pharmacy, ensuring that the correct item and dosage is given. Pharmacists can monitor technician process remotely and review the process to determine if and when a mistake is made. PharmD Chief Pharmacy Officer and Chief Technology Officer Dennis Tribble says, "With IVs, the system takes every dose that needs to be prepared from the pharmacy, and it knows what is supposed to go into that and what bar code in each injectable drug means. It tells someone when they grab the wrong item, and it calculates the dose for them. It gives them the volume in milliliters, and then it captures pictures of the process so if we have to look at it for any reason, we can do that."

The Institute for Safe Medication Practices (ISMP) has issued a report asserting that serious dosing errors continue to occur when heparin is administered to neonates. Specifically, the report cites an incident in Texas in which 17 infants in neonatal intensive care received heparin overdoses. The ISMP said the infants may have received up to 100 times more heparin than intended. The ISMP believes these dosing errors are commonly caused when unannounced changes in the concentration of heparin are made by hospital pharmacies and when the pharmacy does not verify heparin solution concentration for dispensing. Additionally, the ISMP notes that there is no standard dosing protocol for using heparin when flushing venous and arterial lines in neonates. The ISMP suggested that these adverse dosing events could be prevented if the hospital pharmacy dispensed heparin flush solutions that were pre-prepared in the pharmacy or purchased in pre-filled syringes.

The FDA has released a new study which found that consumer medication information (CMI) does not consistently provide accessible, understandable information regarding the risks and benefits of medications. The study, titled "Expert Consumer Evaluation of Consumer Medication Information," showed that while 94 percent of consumers received CMI with their new prescriptions, only 75 percent of this information was considered useful as defined by specific criteria established by a panel of stakeholders. Criteria for appropriate CMI include the drug name and uses; how to monitor for efficacy; contraindications; and symptoms of serious or frequent adverse events. Additionally, all CMI information should be presented in an understandable, legible format. The FDA Risk Communication Advisory Committee will hold a public meeting in early 2009 to discuss the findings of the study. In the meantime the FDA has established a Web site to receive public comment on the study as well as possible future CMI metrics.

Hospira Inc. has issued a voluntary nationwide recall of one lot of 20 mEq potassium chloride in 5 percent dextrose and 0.45 percent sodium chloride injection, USP in 1000 mL flexible plastic containers. The lot number recalled is 65-620-FW, expiration date May 1, 2010. The recall is the result of some containers being labeled as 5 percent dextrose injection, USP. This error could lead to the delivery of the incorrect drug to a patient, leading to potential adverse events including electrolyte imbalance, cardiac dysfunction, gastrointestinal disturbances, parethesia, and mental confusion.

The Ohio State Legislature has passed a new law designed to increase requirements for pharmacy technicians. Once the law is in place pharmacy technicians will need to have a high school diploma or an equivalent certification. They will also need to submit a criminal background check and pass a pharmacist proficiency exam. Additionally, all technicians will be required to wear proper identification. Any violations may incur criminal penalties for both technicians and their employers.

Pharmacy technicians in Kentucky must register with the state's Board of Pharmacy by March 31, 2009. All technicians who submit their registration and the requisite $25 fee will be able to print a certificate of registration, which can be mailed to the Board of Pharmacy. Alternatively, technicians may register via the Internet any time before 12:01 AM April 1, 2009.

As Americans consume more prescription medications, pharmacists need technicians to get the work done. Pharmacy technicians count pills, print labels, obtain health data from patients, and perform other essential tasks. During his career, Miami pharmacy technician Pedro Pluas has gained a number of important skills beyond his basic technician duties including learning to repair medical equipment and prepare intravenous drugs. Pluas sees a growing variety of opportunities for technicians at different types of healthcare facilities. "You can work at hospitals, you can work at IV infusion clinics," he says. As the demand for qualified pharmacy technicians rises, more public and private technical schools and community colleges provide degree and certificate programs for pharmacy techs. Beginning wages for technicians are often about $10 per hour, and the national average is just around $13.50. An ambitious pharmacy tech, however, can acquire specialized skills, many of which result in better pay.