Greetings and happy autumn to my fellow VTSHP members! I am honored to have been chosen President-Elect of the Vermont Society of Health-System Pharmacists. I am very excited about this appointment and look forward to getting to know you over the next few years.

For those of you whom I do not know, I am currently the Pharmacy Manager of Wilcox Home Infusion in Rutland, Vermont. I also oversee our operations in our Williston branch. From these two locations we provide state wide home infusion services for a wide variety of therapies including but not limited to parenteral/enteral nutrition, antibiotics, pain management, steroids, IVIG and chemotherapy. I live in Rutland with my wife Dana and my three children Meridith, Tyler and Anna. Prior to my role at Wilcox my entire career was spent practicing in hospitals around Vermont and New Hampshire. Most recently (5 years ago) as the Pharmacy Director of Pharmacy at Porter Medical Center.

The world of home infusion has opened my eyes to the amazing things pharmacists do across the spectrum of patient care. Healthcare has evolved to a point where very high tech modalities are being provided from the comfort of ones home environment. Part of my role has been to ensure the safe transition of patients from hospital to home while continuing many of the infused therapies that patients were getting in the hospital. I believe that having established lines of communication between the hospital’s and community care pharmacies will continue to become more important as we look to reduce healthcare expenditures in the United States. I can think of no better organization than VTSHP through which we can build the relationships to ensure our patients are cared for in a safe and cost effective manner.

I am sure by now all of you are aware that the Albany College of Pharmacy campus in Colchester began educating students this fall. I will echo Sal’s comments from last year in recognizing the opportunities for professional development the college brings for pharmacists. Just this past month VTSHP hosted a great lecture on new oral chemotherapeutic agents in Montpelier that was given by Joanna Schwartz, Pharm.D, BCOP from the Albany College of Pharmacy. I look forward to building a strong partnership between VTSHP and the college.

In closure I would like to thank our VTSHP President, Sal Morana RPh, PhD for the amazing job he has done this year. Through Sal’s leadership over the last few months VTSHP has stayed on track for a very successful future.

Happy Holidays,
Michael Carroll RPh
President-Elect VTSHP

Health care reform legislation passed by the House of Representatives this month includes several measures championed by ASHP.

The Affordable Health Care for America Act (H.R. 3962) creates a medication therapy management (MTM) grant program managed by the Agency for Healthcare Research and Quality that would enable pharmacists to provide MTM services to chronically ill patients, as part of a coordinated care plan among the patient’s caregivers. The bill also expands eligibility for loan forgiveness to pharmacy graduates who make a commitment to practice in underserved areas.

ASHP actively lobbied for the inclusion of the provisions and educated House members and staffers on the important contributions that pharmacists provide as part of the health care team. ASHP also took a lead role in the work of the coalition, Leadership for Medication Management, which lobbied lawmakers to include the medication therapy management grant provision in the bill.

The ASHP Foundation is offering support for demonstration projects that focus on the pharmacist’s role in promoting vaccination against seasonal influenza. These demonstration projects should address implementation of programs that advance seasonal influenza immunization in healthcare workers during the 2010/2011 influenza season and should incorporate resources from ASHP’s Stop the Flu – It Starts with You resource center.

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No new items have been added to the Joint Commission's list of National Patient Safety Goals (NPSGs) for 2010, but the list has been refined and shortened, and more changes are expected in the future.

Joint Commission Surveyor Darryl Rich said one of the most noticeable changes for 2010 is the absence of NPSG 8, which deals with medication reconciliation. In response to feedback from hospitals, NPSG 8 is not now being scored by surveyors and is on hold until 2011.

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Many hospitals and health systems are looking to expand the roles of pharmacy technicians. For many technicians these new duties may include nuclear pharmacy, medication reconciliation, inventory management, scheduling, investigational drug trials, refill triage, quality assurance, and pharmacy automation. In order to fulfill these new roles, many pharmacy technicians are now receiving expanded education and training. A growing number of health systems now require both certification and training in a program accredited by ASHP. As Janet Teeters, RPh, MS, ASHP director of accreditation services reports, "Hospitals in particular are becoming more demanding in terms of technician education, just as they took the lead in PharmD and residency programs. We expect the development of new practice models to ramp up our accreditation activities."

The FDA has launched the Safe Use Initiative, a program designed to reduce the risk of preventable harm associated with medication use. FDA officials report that millions of individuals are harmed every year from inappropriate medication use due to incomplete access to information about a drug, a patient, or the patient's condition as well as unintentional misuse of medications, medication abuse, and attempts at self harm. To prevent these occurrences, the Safe Use Initiative will encourage collaboration between the FDA, healthcare professionals, and other stakeholders to identify drugs and drug classes that may be associated with an increased risk of preventable harm. A list of specific concerns, cross-sector interventions for reducing harm from these problems, and the metrics for success will also be developed. Several risk-reduction projects that may benefit from Safe Use collaborations have already been identified, including evaluating consumer medication information, communicating about the risk of inadvertent acetaminophen overdose, implementing safeguards against surgery fires associated with alcohol-based surgical preps, and avoiding contamination of multiple use medication vials.

National Pharmacy Technician Day was held on Oct. 27 to acknowledge the contributions of pharmacy technicians to the pharmacy team. Celebrations of the day were held in pharmacies across the country. In order to assist in the recognition of the nation's CPhTs, the Pharmacy Technician Certification Board (PTCB) launched an e-card that could be sent by anyone wanting to show their appreciation. When asked to comment on the day's celebrations, Melissa Murer Corrigan, RPh, Executive Director and CEO of PTCB said, "On National Pharmacy Technician Day, PTCB applauds CPhTs who have passed the rigorous Pharmacy Technician Certification Examination (PTCE) and maintained their certification. Thank you for the positive impact you make on the pharmacy team and the safety of patients."

The FDA has issued guidance to provide applicants and FDA review staff with a definition of established pharmacologic class and to help identify the most appropriate term or phrase that describes the established pharmacologic class for a drug or biological product for inclusion in the Indications and Usage section of the product's approved Prescribing Information. The pharmacologic class of a product may also appear in other sections of its approved labeling; however, it is not required. Drugs that do not have an established pharmacologic class as determined through the structured product labeling (SPL) process, should omit the statement of the drug's class from the Indications and Usage section of its labeling. The FDA instituted the SPL process to make it easier for healthcare professionals to access and read drug information and to make prescribing decisions. Knowing the established pharmacologic class of a drug provides healthcare professionals with important information about what to expect from the product and how it relates to other therapeutic options. Such information also reduces the risk of duplicative therapy and drug interactions as well as providing important treatment information in cases of drug overdose.

Flathead Valley Community College is now accepting applications for the fall 2010 Pharmacy Technology Certificate program, which was launched in partnership with Kalispell Regional Medical Center in Montana to address the shortage of certified pharmacy technicians in the region. The program includes coursework taught by pharmacists at the hospital as well as approximately 12 weeks receiving 20 hours a week of on-the-job training while rotating through a variety of settings including long-term care facilities and hospital pharmacies. Upon successful completion of the 17-credit program, students qualify to take the Certified Pharmacy Technician Exam.

Hospira Inc. and the FDA have issued a notification of the recall of 85 lots of Liposyn II 10 percent, Liposyn II 20 percent, Liposyn III 10 percent, and Liposyn III 20 percent as well as 73 lots of Propofol Injectable Emulsion 1 percent because some containers of these products may contain particulate matter. The source of the matter has been identified as stainless steel equipment used in the manufacturing process. Affected lots of these products were distributed between July 2009 and October 2009. Since these particulate contaminants do not dissolve in the blood they have the potential to act as emboli and impede blood flow. Particulates may also cause mechanical damage to the body and may escalate damage through the Systematic Inflammatory Response Syndrome. Restriction in blood supply to tissues could also lead to stroke, respiratory failure, kidney failure, liver failure, heart attack, and/or death.

Across the country, waves of flu patients have stressed hospital resources, sometimes doubling emergency room volume and causing doctors to open annexes in other parts of the hospital. The Centers for Disease Control and Prevention reported on October 23 that the H1N1 swine flu virus has been responsible for more than 1,000 U.S. deaths and 20,000 hospitalizations. The most serious H1N1 cases and hospitalizations have developed in patients with previous conditions, such as asthma and cystic fibrosis. If the infection rate reaches 35 percent, many states may run out of hospital beds, according to the non-profit Trust for America's Health. Connie Price, chief of infectious diseases at Denver Health, says: "In a typical flu season, we may hospitalize 15 patients. With H1N1, we've hospitalized 10 times that many" already this year. Sara Cosgrove, a member of the infectious-disease team at Johns Hopkins, notes that doctors have stopped her in the hallways to ask for vaccines, even when they are not on the priority list. So far, Johns Hopkins has received only one-fifth of the vaccines it ordered, with the next shipment not due until November. As a result, one quarter of the shipment was given to high-risk patients, while the remainder was divided amongst front-line health personnel and three sister hospitals that had not yet received any vaccine.

GlaxoSmithKline (GSK) and the FDA have reported the death of a patient with influenza who received zanamivir (Relenza) inhalation powder which was solubilized and administered by mechanical ventilation. Zanamivir inhalation powder is not meant to be reconstituted in any liquid formulation and is not recommended for use in any nebulizer or mechanical ventilator because GSK has been unable to determine the safety, efficacy, and stability of the drug when used for nebulization. For this reason, the FDA and GSK recommend that zanamivir inhalation powder be used only as directed and not be administered by nebulization at this time.

New research indicates that initial and maintenance sitagliptin dosing should be at 100 mg daily. For patients with moderate or severe renal insufficiency, researchers recommend downward dose adjustment. The authors conducted a retrospective cohort analysis, using information from an electronic medical record database of a private clinic that included a pharmacist-managed diabetes program. This study is published in the Journal of Managed Care Pharmacy.

A recent study published in the journal Pediatrics found that between 1995 and 2005, an average of 585,922 children were treated each year at emergency rooms and clinics for first-time adverse reactions to medications. Lead author of the study, Dr. Florence Bourgeois of the Children's Hospital in Boston, said that there were no deaths recorded in the data she studied, but 5 percent of the children required hospitalization. Of the children who visited clinics and emergency rooms due to reactions, 43 percent were under the age of five years, while 23 percent were between the ages of 15 and 18 years old. The most common medications associated with adverse reactions were penicillin and other prescription antibiotics. Common reactions that required medical treatment included rashes and gastrointestinal problems. Recent government research shows similar findings. One study indicated that approximately 540,000 of hospitalized children experience adverse events due to medication reactions, errors, and accidental overdoses. Michael Cohen, president of the Institute for Safe Medication Practices, said that a common reason for adverse reactions in children is parental confusion about dosage levels in liquid medications. Such medications are prescribed in drops, teaspoons, or milliliters and parents may mistakenly believe these amounts are interchangeable. To avoid such errors, Cohen recommends that prescribers are clear about dosages with parents and that pharmacists ensure that parents know how to administer medications before they leave the pharmacy.