Hospital Pharmacy

These medication errors have occurred in health care facilities at least once. They will happen again—perhaps where you work. Through education and alertness of personnel and procedural safeguards, they can be avoided. You should consider publishing accounts of errors in your newsletters and/or presenting them at your inservice training programs.

Your assistance is required to continue this feature. The reports described here were received through the Institute for Safe Medication Practices (ISMP) Medication Errors Reporting Program. Any reports published by ISMP will be anonymous. Comments are also invited; the writers' names will be published if desired. ISMP may be contacted at the address shown below.

Errors, close calls, or hazardous conditions may be reported directly to ISMP through the ISMP Web site (www.ismp.org), by calling 800-FAIL-SAFE, or via e-mail at ismpinfo@ismp.org. ISMP guarantees the confidentiality and security of the information received and respects reporters' wishes as to the level of detail included in publications.

The purpose of this feature is to heighten awareness of specific adverse drug reactions (ADRs), discuss methods of prevention, and promote reporting of ADRs to the US Food and Drug Administration's (FDA's) MedWatch program (800-FDA-1088). If you have reported an interesting, preventable ADR to MedWatch, please consider sharing the account with our readers. Write to Dr. Shuster at ISMP, 200 Lakeside Drive, Suite 200, Horsham, PA 19044 (phone: 215-947-7797; fax: 215-914-1492; e-mail: joel.shuster@temple.edu). Your report will be published anonymously unless otherwise requested. This feature is provided by the Institute for Safe Medication Practices (ISMP) in cooperation with the FDA's MedWatch program and Temple University School of Pharmacy. ISMP is an FDA MedWatch partner.

This Hospital Pharmacy feature is extracted from Off-Label Drug Facts, a quarterly publication available from Wolters Kluwer Health. Off-Label Drug Facts is a practitioner-oriented resource for information about specific drug uses that are unapproved by the US Food and Drug Administration. This new guide to the literature enables the health care professional or clinician to quickly identify published studies on off-label uses and determine if a specific use is rational in a patient care scenario. A summary of the most relevant data is provided, including background, study design, patient population, dosage information, therapy duration, results, safety, and therapeutic considerations. References direct the reader to the full literature for more comprehensive information before patient care decisions are made. Direct questions or comments regarding Off-Label Drug Uses to jgeneral@kumc.edu.

Chronic kidney disease (CKD) has become a worldwide public health issue with increasing prevalence in the United States. As kidney function declines, anemia or other complications may arise, and hemodialysis (HD) or kidney transplantation may be needed. Early intervention and treatment of CKD complications will improve clinical outcomes and may delay or prevent disease sequelae. Primary or adjuvant iron replacement in CKD patients with anemia is recommended. The National Kidney Foundation guidelines state that patients receiving erythropoiesis-stimulating agent (ESA) therapy and HD will require intravenous (IV) iron for optimal iron stores and ESA efficacy. This article, the first of a two-part series, details the optimization of IV iron therapy in CKD patients, clinical trial evaluation of IV versus oral iron in the non–HD-dependent CKD patient, and a comparison of the four available IV iron agents. The percent changes in ESA utilization in conjunction with iron therapy and the associated cost savings are also addressed. The second article in this series goes on to describe elements of the medication use process for care of CKD patients with anemia.

Each month, subscribers to The Formulary Monograph Service receive five to six well-documented monographs on drugs that are newly released or are in late phase 3 trials. The monographs are targeted to Pharmacy & Therapeutics Committees. Subscribers also receive monthly 1-page summary monographs on agents that are useful for agendas and pharmacy/nursing inservices. A comprehensive target drug utilization evaluation (DUE) is also provided each month. With a subscription, the monographs are sent in print and are also available online. Monographs can be customized to meet the needs of a facility. Subscribers to The Formulary Monograph Service also receive access to a pharmacy bulletin board, The Formulary Information Exchange (The F.I.X.). All topics pertinent to clinical and hospital pharmacy are discussed on The F.I.X.

Through the cooperation of The Formulary, Hospital Pharmacy publishes selected reviews in this column. For more information about The Formulary Monograph Service or The F.I.X., call The Formulary at 800-322-4349. The March 2010 class review is on calcium channel blockers for injection and the monograph topics are on tocilizumab, capsaicin 8% patch, olanzapine extended-release injectable, von Willebrand factor/coagulation factor VIII complex, and pirfenidone. The DUE is on tocilizumab.

This monthly feature will help readers keep current on new drugs, new indications, dosage forms, and safety-related changes in labeling or use. Efforts have been made to ensure the accuracy of this information; however, if there are any questions, please let us know at bakerdan@wsu.edu.

We are a few months into 2010 and thought we would spend some time looking at a topic that continues to be—and will likely indefinitely be—an important area of focus for the health information technology industry: security and privacy. The topics below are not specific to the current national focus on electronic health records, but we know from following the health and lay news that security and privacy are primary public concerns. This installment looks at parallel security concerns for the health care industry.

The Director's Forum series has been written and edited by Robert Weber and Michael Sanborn and is designed to guide pharmacy leaders in establishing patient-centered services in hospitals and health systems. Effective this issue, Scott M. Mark, PharmD, MS, MEd, FASHP, FACHE, FABC, will assume the responsibilities of editing the column along with Robert Weber, PharmD, MS, BCPS, FASHP. Michael Sanborn, MS, FASHP, will step down as coeditor of this column with this issue. We would like to acknowledge the excellent work done by Mr. Sanborn in originating and editing this column for the last 4 years. His contributions significantly influenced the leadership direction of hospital and health-system pharmacists. Dr. Mark is currently the Director of Pharmacy at the University of Pittsburgh Medical Center and Associate Professor and Vice Chair of Pharmacy at the University of Pittsburgh School of Pharmacy. His practice and teaching are in the area of pharmacy leadership and practice management. We welcome Dr. Mark as a co-editor of the Director's Forum. This month's article focuses on assessing the ability of the pharmacy director in managing the pharmacy's financial operations—a key skill set necessary in developing patient-centered pharmacy services.

Hospital Pharmacy presents this feature to keep pharmacists abreast of new publications in the medical/pharmacy literature. Articles of interest regarding a broad scope of topics are abstracted monthly. Suggestions or comments may be addressed to Jacyntha Sterling, Drug Information Specialist at Saint Francis Hospital, 6161 S Yale Ave, Tulsa, OK 74136 or e-mail: jasterling@saintfrancis.com.