Medication Errors In Hospitals Reduced By e-Prescribing

Medicine shows that commercial electronic prescribing systems (commonly known as e-prescribing, in which prescribers use a computer to order medications for their patients through a system with the help of prompts, aids, and alerts) could substantially reduce prescribing error rates in hospital in-patients. 

In the study, led by Professor Johanna Westbrook from the University of New South Wales in Sydney, Australia, the authors studied the introduction of the Cerner Millennium e-prescribing system into one ward in one hospital (Hospital A), and used three other wards as controls. At another hospital, the authors compared the error rates on two wards before and after the introduction of the e-prescribing system iSoft MedChart. 

The study looked at both procedural (e.g., incomplete, unclear medication orders) and clinical (e.g., wrong dose, wrong drug) orders, and rated the severity of the errors (minor to serious). The researchers found that on the three intervention wards where an e-prescribing system was implemented the procedural prescribing error rates fell by over 90%. 

The researchers found that serious clinical errors declined significantly by 44% on the three wards that used the e-prescribing system whereas the serious clinical error rate fell by 16.7% in control wards that did not get the system. 

The overall rate of clinical errors (those rated as minor to serious combined) did not fall due to the fact that the e-prescribing systems unwittingly introduced some new types of errors called "system-related errors." These included, for example, when a prescriber accidently selected the wrong drug from a drop-down menu item. These system-related errors accounted for 35% of errors occurring in the intervention wards. 

These findings are important as medication errors using hand-written scripts (for example, prescribing the wrong drug or giving a drug by the wrong route), frequently occur in health-care settings and are responsible for thousands of deaths every year. 

The authors admit that the study has limitations, such as the lack of randomization and lack of control wards in Hospital B, but conclude: "Implementation of these commercial e-prescribing systems resulted in significant reductions in prescribing error rates with a significant decline in serious errors observed." 

The authors note: "System-related errors require close attention as they are frequent, but are potentially remediable by system redesign and user training." 

The authors add: "Importantly, the results highlight the need to continually monitor and refine the design of these systems to increase their capacity to improve both the safety and appropriateness of medication use in hospitals."...

10 unbelievable facts of Human Brain

1. Nerve impulses to and from the brain travel as fast as 170 miles per hour. Ever wonder how you can react so fast to things around you or why that stubbed toe hurts right away? It’s due to the super-speedy movement of nerve impulses from your brain to the rest of your body and vice versa, bringing reactions at the speed of a high powered luxury sports car.
2. The brain operates on the same amount of power as 10-watt light bulb. The cartoon image of a light bulb over your head when a great thought occurs isn’t too far off the mark. Your brain generates as much energy as a small light bulb even when you’re sleeping.
3. The human brain cell can hold 5 times as much information as the Encyclopedia Britannica. Or any other encyclopedia for that matter. Scientists have yet to settle on a definitive amount, but the storage capacity of the brain in electronic terms is thought to be between 3 or even 1,000 terabytes. The National Archives of Britain, containing over 900 years of history, only takes up 70 terabytes, making your brain’s memory power pretty darn impressive.
4. Your brain uses 20% of the oxygen that enters your bloodstream.The brain only makes up about 2% of our body mass, yet consumes more oxygen than any other organ in the body, making it extremely susceptible to damage related to oxygen deprivation. So breathe deep to keep your brain happy and swimming in oxygenated cells.
5. The brain is much more active at night than during the day.Logically, you would think that all the moving around, complicated calculations and tasks and general interaction we do on a daily basis during our working hours would take a lot more brain power than, say, lying in bed. Turns out, the opposite is true. When you turn off your brain turns on. Scientists don’t yet know why this is but you can thank the hard work of your brain while you sleep for all those pleasant dreams.
6. Scientists say the higher your I.Q. the more you dream. While this may be true, don’t take it as a sign you’re mentally lacking if you can’t recall your dreams. Most of us don’t remember many of our dreams and the average length of most dreams is only 2-3 seconds–barely long enough to register.
7. Neurons continue to grow throughout human life. For years scientists and doctors thought that brain and neural tissue couldn’t grow or regenerate. While it doesn’t act in the same manner as tissues in many other parts of the body, neurons can and do grow throughout your life, adding a whole new dimension to the study of the brain and the illnesses that affect it.
8. Information travels at different speeds within different types of neurons. Not all neurons are the same. There are a few different types within the body and transmission along these different kinds can be as slow as 0.5 meters/sec or as fast as 120 meters/sec.
9. The brain itself cannot feel pain. While the brain might be the pain center when you cut your finger or burn yourself, the brain itself does not have pain receptors and cannot feel pain. That doesn’t mean your head can’t hurt. The brain is surrounded by loads of tissues, nerves and blood vessels that are plenty receptive to pain and can give you a pounding headache.
10. 80% of the brain is water. Your brain isn’t the firm, gray mass you’ve seen on TV. Living brain tissue is a squishy, pink and jelly-like organ thanks to the loads of blood and high water content of the tissue. So the next time you’re feeling dehydrated get a drink to keep your brain hydrated.

OPPURTUNITIES OF PHARM.D IN USA AND INDIA AN INTERVIEW

Interview with Dr. Padma Sundareshan

Dr. Padma Sundareshan completed her M.Sc. in Biochemistry from Bangalore University. Later
she joined Indian Institute of Science for PhD program after passing preliminary exam she left
for USA due to marriage. In USA she joined the PhD program in Anatomy & cell biology
studied at University of Minnesota, Minneapolis for a year & moved to university of Arizona,
Tucson where she completed her PhD in Anatomy & cell biology. Currently she is doing her
PharmD at Arizona University. She came for internship at Accunova, Manipal, India during this
ACPI has conducted her brief interview regarding style and status of pharmacy practice in USA

Q. what qualification required to work as pharmacist?

In USA presently PharmD is only program after which one can work as pharmacist. PharmD
degree has replaced the Bachelor of Pharmacy degree, which is no longer being awarded.
Previous Bachelor of Pharmacy degree holders are converted their qualification to PharmD with
one year additional program, which is ran by government for certain period of time.

Q. What are the job opportunities after PharmD?

After PharmD one can join as hospital pharmacist or community pharmacist. Some can also
involve in research for pharmaceutical manufacturers, developing new drugs and testing their
effects. Others work in marketing or sales, providing clients with expertise on the use,effectiveness, and possible side effects of drugs. Some pharmacists work for health insurance
companies, developing pharmacy benefit packages and carrying out cost-benefit analyses on
certain drugs. Other pharmacists work for the government, managed care organizations, public
health care services, the armed services, or pharmacy associations.

Q. What about the remuneration & rewards for the pharmacist.

Pharmacist usually works as employee in chain drug home or group of chain pharmacies. The
remuneration for pharmacist is twice a month on hourly basis. Most of the pharmacist work
around 40 hours per week & few works more than 50 hour. Some Pharmacist also works part
time. Average annual pay for community pharmacist is around 100,000 -120,000 US dollar
where as for hospital pharmacist is 70,000-80,000 US dollars. Pharmacist can earn double salary
working on holidays they also have provision of overtime allowance.

Q. what are the regulatory requirement for register pharmacist?

In US license is require to practice pharmacy. All States, U.S. territories and the District of
Columbia require the North American Pharmacist Licensure Exam (NAPLEX), which tests
pharmacy skills and knowledge. Forty-four States and the District of Columbia also require the
Multistate Pharmacy Jurisprudence Exam (MPJE), which tests pharmacy law. Both exams are
administered by the National Association of Boards of Pharmacy (NABP). Each of the eight
States and territories that do not require the MJPE has its own pharmacy law exam. In addition to
the NAPLEX and MPJE, some States and territories require additional exams that are unique to
their jurisdiction.

Q. How community pharmacist access patient’s history?

In USA there are mostly chain pharmacies or group of pharmacies along with this they have
good computer database system. When patients come in pharmacy every prescription is scanned
before filling. Along with softcopy hard copy of prescription is also saved at pharmacy according
to rules for few years. When same patients come for refilling of the prescription computer
immediately shows the history of patients. If patient collected his/ her medication from different
unit of pharmacy even from different city or state that also recorded and updated so it’s easy for
any working pharmacist during working hours to provide good care and prevent mischief.

Q what is social status of pharmacist in USA?

Pharmacists are highly trusted and value very high for the services they provide. They are one of
the important and respectable professions in USA

Q. What is your opinion on PharmD in India?

Since India started PharmD this year it’s difficult to talk now but as per the observation and
discussion with PharmD students at Manipal, India is doing well. Syllabus for PharmD is also structured well. Surely these people will open new doors in clinical practice in Indian health care
system.

Q. what advice you want to give to Indian PharmD students?

The PharmD students should develop leadership and communication skills. For this they should
participate and take active role in different pharmacy association works. Pharmacists should have
scientific aptitude, good interpersonal skills, and a desire to help others. Also student can take
part in IPSF student exchange program so that student can get chance to learn at different
university along with the culture of country.

PHARMD going to replace MBBS

This is article by Dr.Vtharavath in www.targetpg.in saying indirectly that pharmD creating fear in mbbs heart's...






A speech by a senior official of IPA forced me to write this article: I request you to spend few minutes for reading this article.

Is there anybody clearly aware of the PharmD course? If not, here are some points and it is the time to
think about it.( Another headache for the doctor community.)

It is approved by the Government of India, Ministry of Health vide letter No. V.13013/1/2007-PMS dated 13th March 2008 announced in the Gazette on India dated 10th May 2008.

Being a doctoral degree, a person with PharmD qualification can keep Dr. as the prefix to his name. So he becomes a Doctor. It is a course of six year duration after +2 (more than that of MBBS course and imagine the situation of BRMS course!!!) and it should be conducted in a teaching hospital. It is a clinically oriented, community pharmacy course. According to the rules and regulations given by the PCI, the institutions which are starting the PharmD course should provide 300 bed hospital facilities. It is as good as starting a medical college.

As per the PCI guidelines: For PharmD Courses

Hospital posting. Every student shall be posted in constituent hospital for a period of not less than fifty hours to be covered in not less than 200 working days in each of second, third & fourth year course. Each student shall submit report duly certified by the preceptor and duly attested by the Head of the Department or Institution as prescribed. In the fifth year, every student shall spend half a day in the morning hours attending ward rounds on daily basis as a part of clerkship. Theory teaching may be scheduled in the afternoon.

One can understand the truth behind it while going down this article.

According to IPA, the justification for introducing this course is that (recently I came across a speech by a senior official of IPA) in the present days the pharmacists are not getting the required acceptance from the public and health community, because of the existing structure of syllabus and curriculum of the pharmacy courses. According to him there are around 60000 formulations in modern drugs. Hence it is difficult to remember all these formulations and its dosages by a doctor (will it be possible by a compounder to remember all these formulation and its dosages? If he is that much intelligent enough to remember all these formulations, he would not have become a compounder) and hence to eliminate any possible medical errors, the pharmacists must be well equipped with the subject that is clinically oriented and hence the new course. It is designed in such a way that it is more clinically oriented, community based pharmacy course. According to him main job of a PharmD person is to function as an interface between the doctor and the patients and to be with the doctors always during the consultation of patients. That means – that a PharmD person will be always with a doctor to advice the patients on drugs and its dosages.

He said that the Pharmacists are the back bones of the health care system (that means the doctors are peripheral isn’t it?) I heard the above quoted words directly from the IPA official’s speech. That indicated their ambitions and future plans. In practical, according to them, the doctor should only diagnose the disease and give a note to the so called PharmD doctors about the disease and health condition of the patients. Then these pharma doctors will prescribe the medicines (Imagine the situation of the doctor?).

Some of the roles of PharmD (community) pharmacists are as follows:
1. Patient medication history interview
2. Medication order review
3. Patient counseling regarding safe and rational use of drug
4. Adverse drug reaction monitoring
5. Drug interaction monitoring
6. Therapeutic drug monitoring
7. Participating in ward rounds – (what are they going do to there??)
8. Providing drug information at the drug information and poison information centre

That means ultimately doctors are going to loose the entire control of medicines and so called pharma doctors are going to gain the total control of medicines. In such a situation no medical representatives are going to meet the doctors and there will not be any up gradation in the drug information to a doctor. A doctor in the future is going to be unaware of any drug formulations. Doctors need only to diagnose the disease or carry out any clinical procedures and rest will be done by these Pharma doctors. Now the said course is introduced in India as if it is a doctoral qualification for pharmacy students and also to upgrade the Indian pharmacy education standard to the International level. But see that each improvement in this field is, definitely, at the expense of professional importance and freedom of doctors.

Actually this is to bifurcate or to reduce the medical importance of present day’s doctor. Definitely these pharma doctors are the old wine in a new bottle. In olden days when the doctors were less the compounders were practicing modern medicines. I have seen in my child hood days many compounders practicing modern medicine. I believe that this is the latest move by PCI to bring back the extinct “medicine practicing compounders” again. Definitely a tough competition between doctors and pharma doctors will be created in respect of powers, position and importance in the health sector, in the future.

Really we should be ashamed of speaking about our greatness after degrading ourselves by promoting a 3 1/2 year BRMS course. Considering the PharmD course, our MBBS degree must be renamed as DBBS— Bachelor of Diagnosis and Bachelor of Surgery!!! This situation must be considered and must be thought of at the beginning itself. A remedy must be formulated to save the future of the entire doctor community.

It is high time to reorganize and upgrade the structure of modern medicine. Why we are not taking any positive steps in this regard? While every sector in the health care system are trying to upgrade or reorganize their structure and curriculum, we are traveling in the reverse gear— Going down for 31/2 year BRMS course.
In my opinion, MBBS should be of 7 1/2 years duration and the curriculum should be modified to compete with and to maintain the importance of the doctors in the health care system of India.

Or even abolish the Bachelor degree and make the medical degrees as an integrated postgraduate specialized degree instead of mere MBBS graduation.

We cannot stop others from changing, but we have to reorganize or restructure ourselves to go atleast one step in front of others.