January 3, 2013

The Role of the Electronic Health Record in Patient Safety Events – find the article from the Pennsylvania Patient Safety Advisory website here.

December 12, 2012

Pulse Oximeter  -

Before we go into further detail, it is important to note that the parent of any child running a fever of 101 degrees Fahrenheit or more or exhibiting excessive symptoms should consult their primary care physician or local pharmacist.

We all know colds and the flu can be nasty!  However, there are important indicators that mean it’s time to visit a health care professional to make sure the symptoms don’t get the best of us.  One way to keep a “pulse” (no pun intended) on the effects of respiratory infections from colds and the flu is with a pulse oximeter.  A pulse oximeter is a device which tells us what the indirect oxygen saturation is of the hemoglobin of an individual.  In general terms this device gives you an idea of whether or not a person is getting enough oxygen.  For small children with seasonal asthma or the signs and symptoms of the flu, this device can help parents decide whether or not to make a visit to the emergency room.

How does it work?

• A pulse oximeter is a completely non-invasive device that gently overlays a finger, toe or earlobe and reads the absorption of two different kinds of light (red and infrared light) from an LED diode in order to indirectly monitor the oxygen saturation of a person’s blood.
• A pulse oximeter is completely safe.  The red and infrared LED lights are the exact same technology that can be found in a common television remote control.
• These two types of light, when emitted through a translucent part of a person’s body produce a readout indicating the ratio of oxygenated to deoxygenated hemoglobin.
• This ratio is displayed as a percent saturation of peripheral oxygen (%SpO2) on the readout of the device.

What are considered normal and abnormal readings?

• %SpO2 levels between 96% and 99% are normal values and indicate that a person is receiving a completely normal amount of oxygen even if upper respiratory symptoms persist such as coughing, production of phlegm and tightness in the chest.
• %SpO2 levels below 96% are generally considered abnormal but are not necessarily cause for concern.  Many small children will have readings in the low to mid 90% range when they are experiencing symptoms of colds, the flu or upper respiratory infections.  In these cases it is important to consider other physical symptoms when deciding if a visit to the doctor or emergency room is warranted.  Some of these will include the presence of a temperature greater than 101, discolored phlegm or mucous, excessive lethargy and dehydration.
• %SpO2 levels consistently below 92% almost always warrant referrals to the doctor’s office or the emergency room after normal hours.

Does it hurt?

• First of all, as mentioned above the device is completely safe.
• Pulse Oximeters do not hurt at all.  You can even test a child while they sleep without waking them up.

How do I know if my child would benefit from one?

• If your child has been diagnosed with any of the following conditions a pulse oximeter may be a helpful tool for you:
  • o Asthma
  • o Frequent upper respiratory infections

What are the limitations of a pulse oximeter?  Does it ever give inaccurate readings?

• The following conditions can result in inaccurate or false readings and should be considered when using a pulse oximeter at home:
  • o Cold fingers can make it hard for the device to provide a reading.
  • o Anemia can yield normal SpO2 readouts.  However anemic individuals may not be getting adequate oxygen.  If your child is anemic and is experiencing signs of inadequate oxygen consumption (shortness of breath, rapid breathing  fatigue, irritability and/or discoloration  consult your doctor, pharmacist or local emergency room for further advice.
  • o Carbon monoxide poisoning can yield normal or even higher than normal readings (100% SpO2).
  • o Dirty fingers and fingernail polish can give a false low reading.
  • o Sickle cell disease in children can negatively affect the SpO2 results.

How do I get a pulse oximeter and how much do they cost?

• Pulse oximeters can be found at your local pharmacy and typically cost between $30.00 and $150.00 per device.  Unless you are seeking advanced features such as wireless synchronization to computers or mobile phones, a good pulse oximeter can be found at your local drug store for $30-$50.
• Ask your local pharmacist for the device they recommend for your child.

Pharmacists from PharmD on Demand contributed to this article

References:

Clinical Use of Pulse Oximetry.  Pocket Reference 2010.  Retrieved December 10, 2012, from http://www.copd-alert.com/OximetryPG.pdf

How to Read Sp02.  Basic Understanding of the pulse oximeter (2006).  Retrieved December 10, 2012, from http://www.maxtecinc.com/docs/pulsox/aboutPulseOximetry.pdf

Jopling MW, Mannheimer PD, Bebout DE. Issues in the laboratory evaluation of pulse oximeter performance. Anesth Analg. Jan 2002;94(1 Suppl):S62-68.

Oxygen Saturatiuon in Children.  Retrieved December 10, 2012, from http://www.livestrong.com/article/299058-oxygen-saturation-in-children/

December 4, 2012

A recent change in Georgia law could have a major impact on small hospitals across Georgia. This law has eliminated a potential cost-effective option for facilities that cannot financially justify the physical presence of a pharmacist during weekend hours. O.C.G.A. § 26-4-80 which was updated in the 2011-2012 General Assembly Session states the following:

(7) (A) The board shall promulgate rules and regulations under this Code section for institutional settings such as hospital pharmacies, nursing home pharmacies, clinic pharmacies, or pharmacies owned or operated directly by health maintenance organizations.

(B) The rules established pursuant to subparagraph (A) of this paragraph shall specifically authorize hospital pharmacies to use remote order entry when:

(i) The licensed pharmacist is not physically present in the hospital, the hospital pharmacy is closed, and a licensed pharmacist will be physically present in the hospital pharmacy within 16 hours; or

(ii) When at least one licensed pharmacist is physically present in the hospital pharmacy and at least one other licensed pharmacist is practicing pharmacy in the hospital but not physically present in the hospital pharmacy.

This law and the rules being proposed by the Georgia Board of Pharmacy require that small hospital pharmacies that currently use remote pharmacy services as a cost-effective solution to maintain pharmacy oversight during weekend hours are forced to either provide additional on-site staffing hours by a pharmacist or remove any pharmacy services during that time period. This reduction in prospective medication order review will result in an increase in medication errors, and potentially patient harm and increased length of hospitalization.

In addition to the reduction in patient safety, it will affect your ability to be compliant with TJC MM.05.01.01. This Joint Commission standard requires a pharmacist’s review of all medication orders prior to dispensing or removal from floor stock or an automated dispensing device unless a licensed independent practitioner controls the ordering, preparation, and administration of the medication or in cases where delay would cause patient harm in an urgent situation.

Likewise, CMS Regulation §482.25(b) states that all medications (except in emergency situations) should be reviewed for appropriateness by a pharmacist before the first dose is dispensed.

This new law forces you to either spend more money to have a pharmacist physically present on the weekends or to do without remote pharmacy review which subsequently makes you non-compliant to the above standards.

Written comments on the proposed rule are due no later than December 7, 2012 and can be faxed to 866-888-1308.  A public hearing is scheduled to begin at 9:30 a.m. on December 12, 2012 at the Professional Licensing Boards Division, 237 Coliseum Drive, Macon, Georgia 31217 to provide the public an opportunity to comment upon and provide input into the proposed amended rule. At the public hearing anyone may present data, make a statement, comment or offer a viewpoint or argument whether orally or in writing.

The law may be accessed at http://www.lexisnexis.com/hottopics/gacode/ and searching for 26-4-80.

November 2, 2012

Rx Response has their report status listed as Engaged, in an effort to help patients affected on the East coast maintain access to their medications.  Rx Response’s Hurricane Sandy Situation Report provides helpful tidbits of news, and their Pharmacy Status Map provides a thorough listing of open pharmacies in those areas dealing with Sandy’s aftermath.

Direct Relief International, a nonprofit medical assistance and disaster relief agency, committed $250,000 and its entire stock of available medical inventory to the storm’s recovery efforts.  According to their official press release announcement, several of the organization’s corporate contributers -  including Abbott, BD, Eli Lilly, Johnson & Johnson, and Teva – have also offered their support in providing medical and personal care supplies to those in need.

For those who wish to help, contributions may be made to one of the numerous volunteer organizations available.  The National Donations Management Network is a good resource in selecting where to allocate charitable resources.