The Pharmacist's true Halloween Terror: Medication Errors

I think we all remember the 20/20 piece from last spring-if not here's the video for a reminder. For further comments-here's the ABC blog with many comments on either side-so I won't belabor the topic here....too much ;-)

A positive aspect of this whole topic, however difficult it may be to discuss, is that is acts like a "Call to Action" in the public and in the media (again with the media discussion, Jared...seriously-we get it.) Towards this end, CNN now has an "Empowered Patient" series that encourages patients to be more involved in their health care. This week, the main article deals with minimizing pharmacy errors and ways to talk to your pharmacist and what you can do to minimize pharmacy errors.

I also found a newsletter that you can receive from the Institute of Safe Medication Practices that looks pretty interesting. The ISMP is an entire area that we don't hear anything about-and with the public concern of medication errors, I think we should make this more of an issue and be more proactive about it, rather than reactive.

The more we look at medication distribution and realize that the value that pharmacists add to the health care system is not in distribution but our cognitive services, the further I believe we can push the profession and practice the way we feel it should be practiced. Reducing medication errors are a HUGE area where we can make a difference, but we also need to let the public know that pharmacy is SOOO much more.

What happens if MRSA gets confused with MPSA?

....oh, the implications. So....I do indeed make bad jokes. Whatever.

Usually, conversations with friends and family that turn to pharmacy will either be them a) showing me a rash b) complaining about how much their co-pay is and not realizing how much is actually being paid for (that's another blog...) or c) questions about what I want to do when I graduate, to which I usually espouse the multitude of opportunities available in pharmacy. Now, however, the new questions have revolved around MRSA-methicilling resistant staph aureus.

The original questions began after the CNN article ran a couple of weeks ago, in response to the JAMA article and also the death of a student who contracted the infection at school (and other deaths that are now coming to light.) Though MRSA has been an issue and of concern in hospitals for years, it is great to see this get people's attention and have more people realize the impact of antibiotic resistance and its implications. Still, it's pretty scary to think when the "Vancomycin resistant Staph Aureous" super bug comes along, or linezolid resistant, etc. There is at least one drug-Televancin that recently received an "approvable letter" from the FDA that is in the pipeline and not too far from approval-I'm not sure of others.

In addition, there is always the prevention route to slowing down the spread of MRSA. While some hospitals will likely do a deep clean to rid the hospital of the bug-this BBC article suggests that merely keeping up on general cleaning, even with just soap and water, cleans up the bug. Of course, proper and frequent hand washing is the biggest step in preventing the spread of this "superbug."

Also, last weekend over MRM, there was a very interesting proposed resolution that requested cleaning our white coats. I was at first like much of the rest of the contingent at the meeting, and thought the resolution was a bit hammy-but the explanation of the reasoning was not far at all from being off the mark. In Britain, there is a possibility that there may be a ban on white coats, and many hospitals, at the suggestion of the British Medical Association, have already banned ties across the pond. I think this was a great idea and a very proactive approach to helping resolve the MRSA problem, and a huge opportunity for student pharmacists in the US to take an opportunity to help public health and stop the spread of infectious disease (and don't get me started on the internet resolution....)

Pharmacist Indicted for Med Error

Mistakes. We all make them. But, to what extent should we as pharmacists be held accountable? In Ohio, a pharmacist is being indicted for a med error that led to the death of a 2 year-old girl-here's the link. The discussion on the matter and impact on the profession is also very interesting and the ethics surrounding it are intriguing. There is also mention of mandated pharmacy technician training as well. Here's an article that goes a bit more in depth on the circumstances of the error and subsequent death, as well as more information on Emily's Law.

Eric Cropp, the pharmacist who performed the final double check on the chemo IV that ultimately killed Emily Jerry, has had his license revoked. Here's the testimony from the Jerry family. It's pretty intense, just to warn you. Here are the Ohio State Board of Pharmacy Minutes of that session-the testimony and conclusion are on pages 21-25.

A lot to think about witht his issue-we could probably hold an entire meeting discussing this as we did with the 20/20 piece on med errors last year. I'll try and keep everyone updated on this one.

Taxol not as effective as first thought

This article from the Star Trib was forwarded on to me, and I thought it was very timely for what third years have been studying. Taxol or paclitaxel is used for women with breast cancer, but it appears to be more effective in women who are HER-2 positive. I will write more later-here's the New England Journal of Medicine article as well.

Topiramate for treatment of alcoholism?

Topiramate/Topamax is commonly used for epilepsy and for migraines. A new study suggests it may be effective in treating alcoholism as well. Here's the CNN article on the topic, and the JAMA article on it too. Though it didn't work for a ton of the study participants (all of whom were heavy drinkers/alcoholics) it did work for a statistically significant proportion of people. Overall drinking decreased in both arms. There are quite a few limits to the study, but it didn't sound like the manufacturer of Topamax, Ortho-McNeill, was interested in pursuing FDA approval for the drug, though they did fund this study. Just to be cynical, Topamax goes off patent next year, and according to the CNN article, they can't market Topamax for alcoholism unless it's FDA approved for the condition.

I thought it was interesting that they felt it was moving towards what Prozac did for depression, and give, in this case, alcoholics a more private way to deal with their illness, rather than entering rehab clinic to dry out. A couple limitations to the study as well: They only followed the patients for 14 weeks, the dose seemed a bit high and thus caused a high incidence of side effects, and, like smoking cessation, I'd really be interested to see this double blinded to included some behavioural modification/support with it as well. Interesting direction with treatment of alcoholism, we'll see where it leads.

Student Pharmacists on Morning Shows

I think we mentioned this in a meeting or two, but this definitely deserves more notice. On Oct. 4th, pharmacists and student pharmacists hung around outside of a bunch of morning news programs and got some airtime, and encourage everyone to, say it with me: "Know your medicine, know your pharmacist." Here's the APhA press release and some pictures of the event. I looked for videos of the event, but didn't find anything. If I do, be assured I'll post it. But, just for good measure, here's a little enjoyable video that many of you may have seen already.

FDA to consider new class of drugs

The FDA has been making some pharmacy news lately, which only makes sense for the Food and DRUG Administration. Apparently the FDA announced back in March at the Annual Meeting in Atlanta that they were going to look closer at the creation of a third class. This floated under the radar for most of us, until the FDA released a statement announcing that they were going to have a public meeting on November 14th to discuss the issue (it's in Washington though...bummer. Oh, and it's a long statement from the FDA too, I think it's just kind of cool to have the original document posted. Gotta love the internet!!) Here are a couple articles on the issue as well: a CNN/Dowjones article and a Reuters article that is a little more in depth and some commentary from mainly OTC companies (they're against it) and from the National Association of Drug Chain Stores (they're for it).

This will be a very interesting story to follow in the coming months, and though I won't be able to make it, here's the link to register for the meeting in D.C. Let me know how it is. However, for a more accessible way to voice your opinion, here's the link to submit comments to the FDA-the link is open until November 28th. Here's your chance to tell the FDA what you think about having a third class of drugs!

Clean Air Act Credited with decreasing Heart Attacks

A recent study in New York found that their 2003 Clean Air Act may have contributed to an 8% drop in heart attacks. Aside from returning from bars and NOT smelling like smoke, I guess an added benefit would be a decrease in risk of an MI. BONUS!!

FDA Updates

A couple of people have let me know about this, so I had better blog on it.

The FDA is beginning a "Drug Safety Newsletter." This will be a quarterly newsletter that will keep you abreast of drug safety reviews, the Adverse Event Reporting System, and many current drug updates. Looks like the blog might be getting replaced after only a couple weeks....

Type II Diabetics QOL Study

Thank you to Ryan Pederson, ex-pres, for forwarding this on. I'm a little late in posting it, and I apologize for that.

This is an absolutely fascinating article discussing the quality of life for diabetics patients. I couldn't find the actual article online (stupid journal limited access....ggrrrrr) but here's the abstract on it.



The gist of the article is this: Patients diagnosed with Type II diabetes would rather deal with the complications of the disease itself i.e. kidney issues, increased risk of cardiovascular death, blindness, loss of limbs etc. in exchange for not having to take all the pills to lower blood glucose, diet and exercise, insulin, and deal with the inconvenience and cost of dealing with their diabetes now.



I think the quote by the lead author Dr. Elbert Huang, assistant professor at the University of Chicago makes many good points:



"The people who care for patients with a chronic disease like diabetes think about that disease and about preventing long-term complications. The people who have a chronic disease think about their immediate lives, which include the day-to-day costs and inconvenience of a multi-drug regimen. The consequences are often poor compliance, which means long-term complications, which will then require more medications."



I think his statement raises many, many questions. How do we as pharmacists approach our treatment? We look at it as a correct answer-Patient has disease X, we treat with drug Y. Next question/patient. Real life, or so I am told since I'm just a student, is a bit more complicated. How will the patient respond, how do we respond, is this what the patient wants, etc. And all of this then deals with compliance, which is of course a huge concern because (and this may come as a surprise to many of you) if you don't take a drug, it doesn't actually work.

I was also very surprised by this for a moment, but then after some thinking about it, I realized that a patient that has had poor diet and minimal exercise-a lifestyle stereotypical of many Type II diabetics-probably won't really like trying to jump through all of the hoops necessary to turn around their lifestyle of poor health.

Other ideas that I won't address since this is already meandering and verbose-but what about the burden on health care for their end-of-life care, how do we then treat patients that aren't complying, and are we simply enabling their poor health by not chastizing them on their lack of compliance

CFC to HFA Albuterol Inhalers

If you work in a community pharmacy lately-you've probably noticed the change from the CFC albuterol inhaler to the HFA inhalers-most likely to the "ProAir" or "Ventolin" HFA, or some others. Usually you just switch the patient over to the HFA inhaler, and none's the wiser-but are they really equivalent?


As Sarah Mallak discussed in MPSA, though there are a lot of similarities between the two options, there are some special consideration we as pharmacists/students need to think about when we dispense them to patients, particularly for the first time. Patients should be instructed to wash their HFA inhaler canister once a week in warm water to prevent clogging. Further information can be found on the article "Withdrawal of albuterol inhalers containing chlorofluorocarbons" in NEJM-I'd link it but I'm not able due to restrictions. A very interesting read!!!