It looks like ‘maybe’ spring is finally here in Vermont. At least that is the way it felt at our Annual Spring Meeting on Saturday, April 4th. The Holiday Inn was buzzing with 80 pharmacists and technicians attending what proved to be a very informative meeting.

The day started with Dr. Ron Debellis, Pharm D giving us an entertaining talk on the soon-to-open Vermont campus of the Albany College of Pharmacy. Ron did a great job getting us all excited about having these young “pharmacists-to-be” so close to our practice sites. We are all looking forward to being mentors and having a ready pool of pharmacists to work at our sites.

Next, Dr. Marie George, MD, gave us an update on Lyme Disease in Vermont. Her epidemic information was alarming, as we were informed of the increasing numbers of Lyme Disease, heading north through the counties. Those of us who spend lots of time outdoors need to be more aware of looking for these ticks…and I’d advise everyone to keep the dog off the couch.

After a technical glitch, Dr. Tom Lodise, Pharm D, enlightened us with antibiotic dosing wisdom. His extensive knowledge on how to use antibiotics to best meet the needs of the patient was practical and very informative. Each of us should have brought home a useful nugget of advice which we can put to use daily in our practice.

Dr. Jill Kolesar, Pharm D, brought us up to date on the newest treatments for the rare but life-threatening disease Immune Thrombocytopenia Purpura (ITP). This timely presentation brought to the forefront the development of two new medications to treat ITP and addressed the pharmacoeconomics of these treatments.

Dr. Marc Stranz, Pharm D, updated us on the history and future development of specialty infusion pharmacy. This type of pharmacy practice will be a challenge for patients who need medications which are only available through non-traditional distribution channels. It will be an interesting future for the world of pharmacy.

Dr. Terry Rabinowitz, MD, ended our day with a delightful discussion on telepharmacy and the potentials for its use in our rural state. He infused his presentation with anecdotes of his current use of telemedicine in his psychiatry practice and the successes he has had. Remote pharmacy services have been crucial in maintaining pharmacy services to many rural areas around the country, including here in Vermont. Expect to see more of it as systems are developed.

As noted, this year’s VtSHP Annual Meeting showcased a wide range of topics. I’m sure everyone went home with some new tidbit of information. Each year we strive to choose timely issues for the practice of pharmacy. We are always open to new ideas and encourage anyone who has a topic which they would like to hear more about to submit their idea to any of the officers.

Our next meeting will be held at the Waybury Inn in East Middlebury on Thursday, May 21st. We will be featuring a “Clinical Pearls” format. We still have openings for a couple of presenters. For more information, contact Sal Morana at 802-388-5632.

Pharmacy departments in hospitals and health systems across the U.S. are facing workforce and budget challenges as health care institutions navigate the current economic environment, according to results of the ASHP Survey of the Impact of the Current Economy on Pharmacy Services in Hospitals and Health Systems.

The survey of 541 U.S. hospitals, conducted by the American Society of Health-System Pharmacists (ASHP) Section of Pharmacy Practice Managers, asked participants about the economy’s impact on payroll and employment, cost and capital investment management, pharmacy services, and education and professional development. Highlights from the survey include:

• 37 percent of respondents have had their staffing budgets reduced in the last six months
• 10 percent of respondents have laid off personnel and 22 percent have frozen vacant positions
• 66 percent of respondents have been required to reduce their drug budgets
• Among respondents that have student rotations, 16 percent reported that they will reduce the number of rotations
• Among respondents that have accredited first-year residency programs, 7 percent will be reducing residency positions

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It’s election time again and VtSHP is looking for candidates for President-Elect. This is a 3-yr commitment to a great opportunity to make a significant contribution to Health-System Pharmacy in Vermont. Serving on the board of VtSHP provides great net-working opportunities not only in Vermont, but with ASHP, also. The collaboration between the two organizations is excellent. It will also give you great exposure with the new Vermont Campus of the Albany College of Pharmacy. We will be working closely with ACP in providing educational opportunities for the students and our members, too. Consider nominating yourself or a colleague for this great opportunity! Contact Clare Coppock at 802-772-2469 to discuss.

Now is the time to submit your nominations for either pharmacist of the year or pharmacy technician of the year. We would like to be able to present these awards at our May meeting. If you would like to nominate a collegue, contact Lisa Jackman at Lisa.Jackman@vtmednet.com for a form. We would like to recognize colleagues who have made exceptional contributions to the practice of pharmacy.

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.

Want to know what ASHP has done for you lately? Check out ASHP's new annual report. The report, which offers an overview of all of ASHP's significant activities and initiatives over the last year, is now available as an interactive Web publication, allowing you to take a closer look at the resources the Society offers. Come see how ASHP supports your professional goals, helps you manage on-the-job challenges, and serves as your voice to legislative bodies and regulatory agencies like The Joint Commission and Centers for Medicaid & Medicare.

Click here to read the Annual Report.

A proposal by the Food and Drug Administration (FDA) to use a serialized National Drug Code (NDC) to secure the drug supply would not help in the adoption of bar-code medication administration and may be vulnerable to drug counterfeiters, ASHP told the agency this week. ASHP also reiterated the need for the FDA to begin exploring the development of a more effective alternative to the NDC.

FDA is developing a standardized numerical identifier that would be applied to medication packages by manufacturers or repackagers.

Click here to read ASHP’s letter.

ASHP Executive Vice President and CEO Henri R. Manasse, Jr., Ph.D., Sc.D., this week urged members of the Senate Finance Committee to restore funding for Post Graduate Year 2 (PGY2) specialized pharmacy residency programs in health care reform legislation.

ASHP’s grassroots advocacy team is also working with members in Montana and Iowa in targeted outreach to Senators Max Baucus (D-Mont.) and Charles Grassley (R-Iowa), the chair and ranking minority member of the Senate Finance committee, on the issue.

Click here to read Manasse’s letter to the Senate Finance Committee. For more information on ASHP’s advocacy to restore PGY2 residency funding contact Joe Hill in the ASHP Government Affairs Division at gad@ashp.org.

A standardized drug coding system will help facilitate safe medication use across the continuum of care, ASHP told Gov. Kathleen Sebelius, secretary-designate, U.S. Department of Health and Human Services this week.

Click here to read ASHP’s letter.

A 2006 Institute of Medicine (IOM) report on the state of pediatric emergency medicine in the United States concluded that, among other things, continuing education in pediatric care is not mandated or is very limited for many hospital staff members involved in emergency care. Other findings included that many medications prescribed to children have not been adequately tested or green-lit by the U.S. Food and Drug Administration, and only about 6 percent of emergency departments have all the necessary supplies for handling pediatric emergencies. The IOM reporting committee has recommended the congressional establishment of a Health Resources and Services Administration-managed program to promote regionalized, coordinated, and accountable emergency care systems throughout the nation, and that $88 million be devoted over five years to the program. A lead agency for emergency and trauma care residing in the Department of Health and Human Services (HHS) would be set up, and its responsibilities would encompass the complete spectrum of emergency medical services (EMS), emergency and trauma care for adults and children, including medical 911 and emergency medical dispatch, pre-hospital EMS, hospital-based emergency and trauma care, and medical-related disaster preparedness. Hospitals and EMS systems must deploy evidence-based approaches to reduce errors in emergency and trauma care for children, and the IOM committee recommends that HHS and the National Highway Traffic Safety Administration underwrite the development of medication dosage guidelines, formulations, labeling guidelines, and administration methods for the emergency treatment setting to optimize effectiveness and safety for infants, children, and teenagers.

For patients with atrial fibrillation unsuitable for vitamin K-antagonist therapy, the addition of clopidogrel to aspirin reduced the risk of major vascular events and increased the risk of major hemorrhage, according to researchers of a recently published study. The study involved 7,554 patients with atrial fibrillation and increased risk of stroke who could not undergo vitamin K-antagonist therapy. They were randomly assigned to receive clopidogrel (3,772 patients) or placebo (3,782 patients) once daily, in addition to aspirin. Of the patients taking clopidogrel, 6.8 percent experienced a major vascular event, including stroke, myocardial infarction, or death, compared to 7.6 percent of the placebo group, with the reduction in vascular risk attributed primarily to a reduction in strokes. Major bleeding occurred in about 2 percent of the clopidogrel group, compared to 1.3 percent in the placebo group, although there was no significant difference between the groups when combining major vascular events and major hemorrhage.

Tamiflu (oseltamivir) is one of two relatively new anti-flu medications that can reduce the severity and duration of influenza, but one flu strain, type A H1N1, has developed a resistance to the drug. Patients with H1N1 flu can be treated with Relenza (zanamavir) if it is inhaled, or they can take amantadine or rimantadine, though these drugs do not work for some flu strains. Most doctors do not know which flu strains their patients have, and viral cultures can take a week to produce results. Because of this uncertainty, SHEA Board Member Connie Price, infectious-disease specialist at Denver Health Medical Center, recommended that doctors treating flu patients at her hospital use Relenza, if possible, and when not, to combine Tamiflu with one of the older drugs, such as rimantadine. The U.S. Centers for Disease Control and Prevention's most recent report said that the flu is widespread in 30 states and 32 children have died from the disease since the season began in September.

At the recent annual meeting of the Society for Healthcare Epidemiology of America, three studies were presented that provide possible ways to eliminate methicillin-resistant Staphylococcus aureus (MRSA). University of Iowa's Dr. Philip Polgreen, assistant professor of internal medicine, presented a new electronic monitoring system that uses badges worn by healthcare workers and sensors on automated hygiene dispensers in or near patient rooms to monitor compliance with hand hygiene policies. Researchers from the University of California at Irvine presented data indicating that touching surfaces is responsible for 40 percent of MRSA and vancomycin-resistant enterococci infections and revealed that cleaning patient rooms with disinfectant saturated cloths instead of spray bottles reduces the spread of MRSA. The last study, presented by Dr. Susan Huang, director of epidemiology and infection prevention at the University of California at Irvine School of Medicine, called for routine decontamination of patients to prevent the spread of bacteria from one hospital to another.

Certain economic segments have plenty of job openings, including health care, which the U.S. Bureau of Labor Statistics has identified as a growing industry that promises stable employment opportunities. Hiring has continued non-stop at hospital, out-patient clinics and physician offices, with demand for nearly every medical profession, including lab technicians, remaining high.

Elderly patients may have a higher risk of drug-related cognitive impairment, according to a recent article posted by Public Citizen. The article includes the names of 136 commonly prescribed drugs that the consumer research and advocacy group believes may potentially be associated with cognitive health risks for older patients. The list includes antihistamines, anticholinergics, and sleep aids. The article maintains that these medications may have higher risks for older patients because of their increased sensitivity to a drug's effects, slower rates of elimination from the body, and use of multiple medications.

The FDA and Novartis recently announced that the Medication Guide for mycophenolic acid (Myfortic) will be included with every bottle of the drug by May 15, 2009. The Medication Guide is designed to provide patients with easily understandable safety information regarding mycophenolic acid. Pharmacists will be required to distribute this guide with all prescriptions.

U.S. President Barack Obama's goal of creating electronic health records (EHRs) for every citizen by 2014 has a long way to go. Less than two percent of U.S. hospitals currently use comprehensive electronic health records, according to a study by David Blumenthal, Obama's national coordinator for health information technology. Blumenthal says the $19 billion in funding for healthcare information technology and other provisions in the new stimulus bill will be used to address the two major obstacles to comprehensive EHRs: the cost of implementing and maintaining those records and the difficulty of exchanging information between healthcare providers' computer systems. The study found that about 8 percent of U.S. hospitals use basic EHR systems in at least one department, but that only a quarter of those hospitals use comprehensive EHR systems, such as decision support systems that help physicians and healthcare providers make treatment decisions. Individual electronic functions are more common. For example, about 16 percent of hospitals use electronic ordering systems for medication and more than 75 percent of hospitals use electronic systems for the results of laboratory and radiology tests. The survey covered about 63 percent of all acute-care general hospitals in the United States. The survey results reflect a similar report released last year, which found that 17 percent of doctors use comprehensive EHR systems. Hospital administrators cited cost as the major barrier to adopting EHR systems. Another problem is that many hospitals have different systems in different departments that do not work with each other.

Some hospitals are turning to Business Rule Management System (B.R.M.S.) technology to reduce medical and medication errors. Vanderbilt University Medical Center, for instance, is working with its software vendor to develop systems that centralize data from patient monitors, pharmacy and doctor paging systems. The system monitors this data and alerts doctors when a patient's condition changes suddenly. It also predicts necessary procedures based on diagnoses and can detect sepsis, blood-clotting abnormalities and other conditions to prevent longer hospital stays and costly procedures. The hospital says doctors and nurses are responding more quickly to changes in condition following the system's implementation, and more conditions are being detected early.

Children under the age of four years who receive anesthesia twice could be 59 percent more likely to develop a learning disability, according to an analysis of data from a medical registry. The researchers examined information on people born on Olmstead County, Minn., between 1976 and 1982, identifying 593 children who received anesthesia before age four, and 4,764 children who did not. This information was compared to school records that designated some children as learning disabled, defined as a lower score in reading, math, and writing than what their IQ would indicate. Children who received anesthesia only once were no more likely to be learning disabled, but children who received it three times or more were more than twice as likely to be learning disabled as those who never received it. Children who were anesthetized for two hours or more showed the greatest risk of developing a learning disability. The study authors, including Randall Flick, pediatrician and anesthesiologist at the Mayo Clinic in Rochester, Minn., said they do not know if the drugs themselves are responsible for the learning disabilities, or if the children who need surgeries are already prone to learning disabilities. Pediatric anesthesiologist Tom Hansen, of Odense University Hospital in Denmark, pointed out that about one-third of the study's original children moved away before age five, possibly over-representing those who stayed closer to the Mayo Clinic for medical reasons. Some studies in young animals, however, suggest that general anesthesia can impair learning. The researchers reported the human study in the April issue of Anesthesiology.

Ed L. Hamilton, the director of pharmacy for Winter Haven Hospital's Regency Medical Center in Winter Haven, Fla., notes the pharmacist is a patent's most accessible health-care provider. "We want to see ... that the pharmacist, a trained professional regarding medications, has access to the patients' records and works more as a team worker for the patient to get the most out of those medications," he says. "The whole idea of a prescription is the health outcome of the patient," Hamilton adds. "We are highly trained in medication therapy, but our skills are not being fully used. If we could get computerized access to the health-care documents of our patients, we could work with their health-care provider. Our role is to help the patient use the medication properly. If the patient doesn't fully grasp how to use the medication, then the patient won't reap the full benefits of it." Hamilton points out that "in the hospital situation, we only have that patient for a limited time. But to expand that to the pharmacist to have that patient's same information, the pharmacist can see if the (medication) dose needs to be adjusted."

The U.S. Food and Drug Administration (FDA) has issued an alert reminding healthcare professionals that single-patient insulin pens and cartridges should not be used to give medication to multiple patients, as this increases the risk of transmitting diseases such as HIV and hepatitis. According to the FDA, more than 2,000 people were involved in incidents at two undisclosed hospitals in which the cartridges of insulin pens were being reused, though the disposable needles were reportedly changed between patients. Patients exposed to these shared pens are being contacted for free hepatitis and HIV testing. Dr. Amy Egan, deputy director of safety at the FDA’s Division of Metabolism and Endocrinology Products in the Center for Drug Evaluation and Research (CDER), said: "Insulin pens are designed to be safe for one patient to use one pen multiple times with a new, fresh needle for each injection."

Anti-angiogenesis drugs can reduce edema caused by glioblastomas and prevent the formation of new blood vessels that feed the growth of tumors, according to a new study by a team at Massachusetts General Hospital (MGH). The experimental anti-angiogenesis drug cediranib reduced edema and improved survival in mice with glioblastomas by inhibiting an angiogenesis factor called VEGF, abundant in glioblastomas. Study co-senior author Rakesh K. Jain, director of the Steele Laboratory in MGH's radiation oncology department, said that this is the first paper to show that vascular normalization can be effective against tumors by controlling edema without chemotherapy. The control of edema is also better with the anti-angiogenesis than with currently used steroids, Jain said. However, anti-VEGF agents did not slow tumor growth in the mice, and may not significantly contribute to increased patient survival. The study was published online in the Journal of Clinical Oncology.

Many of the hospitals designated "Most Wired" by Hospitals & Health Networks magazine have achieved higher efficiency and improved patient safety through computerized provider order entry (CPOE) systems. However, only 17 percent of hospitals with more than 200 beds have implemented such systems, says a report from technology consultant KLAS, which experts attribute to confusion about how to do so. According Agency for Healthcare Research and Quality director Carolyn Clancy, MD, "To affect quality, safety and efficiency through the use of CPOE, you need to change the way you do things, and many organizations are hesitant." Hospital executives at Most Wired hospitals say it is important to form a team of physicians, nurses, pharmacists and ancillary staff to build the standardized evidence-based order sets. They also should allow doctors to deviate from the order sets except when dealing with drug interactions and other critical safety issues. Such a move alerts hospital management, making it possible for them to speak with doctors to reinforce best practices or determine when changes to the order sets are necessary. With regard to alerts, some hospitals have maintained only the critical alerts for physicians and specialists and all alerts for the pharmacy. In some instances, hospitals must custom build alerts; Piedmon Hospital in Atlanta, Ga., for example, created an alert to warn physicians about the dangers of prescribing blood thinners for patients with epidural catheters, which could cause bleeding around the spinal cord.