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  • March 29, 2004 2:43 PM | Brad Miller (Administrator)

    This month our education program is slightly different than most programs. Two pharmacy practice residents will present their residency projects that they have been working on during the year. This year Dana Staat from Spectrum Health in Grand Rapids and Michelle Brodin from Mercy Health System in Muskegon have been selected.

    Dana completed her pre-Pharmacy education and Pharm.D. degree through Ferris State University. Dana’s project is entitled "The Development and Implementation of a Pharmacy Competency Program". This was formed around the premise that health care is a rapidly changing field that requires constant education and a commitment to learn. Competencies are one way to accomplish continual education and training. To begin this continual process at Spectrum Health, a survey was administered to pharmacists to gauge the interests and needs that each individual pharmacist required for optimal education. After the results of the survey were tabulated, it was clear that a combination of CE and a shared-drive-based packet would serve best as a competency tool. Community-acquired pneumonia was chosen as the pilot focus for the competency template. After the competency was given, a follow-up survey was distributed to the same pharmacists to gain further information on the effectiveness of this education process. Documentation of pharmacist competency was also created as part of the formation of the competency program. Results of the effectiveness of the competency template will be reported at the April WMSHP meeting.

    Michelle received her Pharm.D. from South Dakota State University College of Pharmacy in May of 2003. Michelle’s project involves anemia management in renal failure. She is working with area nephrologists to develop and improve a pre-dialysis monitoring service for outpatient kidney disease patients who are on either Procrit or Aranesp. She will describe their current practice and outline future plans for the service. Included in her evaluation of the project will be dosing of the medications, hemoglobin goals, hemoglobin monitoring frequency, iron lab frequency, management of missed doses, and a cost assessment. Since it is in the early stages, it is difficult to draw many conclusions on the success of the program, however preliminary data look promising.

  • March 29, 2004 2:42 PM | Brad Miller (Administrator)

    Ironically, some of the most serious consequences of hypernatremia can result not from the condition itself but from the inappropriate management of the condition. The intravenous infusion of profoundly hypotonic solutions can lead to hemolysis and other severe consequences.

    Jennifer Hagerman, Pharmacy Practice Resident at Borgess Medical Center, writes of the dangers of sterile water in the April WMSHP Newsletter.

    ____

    Even Water Can Be Dangerous

    Jennifer Hagerman, Pharm.D.

    ____

    Hypernatremia, defined as a serum sodium concentration greater than 145 mEq/L, is a serious electrolyte disorder and is associated with significant mortality in the hospitalized patient. Ironically, some of the most serious consequences of hypernatremia can result not from the condition itself but from the inappropriate management of the condition. The Institute for Safe Medication Practices (ISMP) has recently published several reports of medication errors involving the inappropriate management of hypernatremia. Most of the reports involved physicians who wrote for “plain water” or “free water” to be administered intravenously. Free water does not contain any additives to normalize tonicity and as a result has an osmolality of 0 mOsm/L.

    In the body, normal serum osmolality is tightly regulated between 275 – 290 mOsm/L. The intravenous infusion of profoundly hypotonic solutions can lead to hemolysis and other severe consequences. Although sterile water can be administered orally for the treatment of hypernatremia, it should never be administered intravenously without additives to normalize tonicity.

    In one case cited by ISMP, an elderly patient was admitted to the intensive care unit (ICU) with severe hypernatremia. The patient also presented with congestive heart failure, pneumonia, respiratory failure and hyperglycemia. The physician decided that the rising serum sodium precluded the further use of sodium solutions and that the presence of hyperglycemia made the use of dextrose solutions undesirable. These circumstances lead to the physician’s ill-fated decision to order “free water” to be administered through a peripheral IV at 100 mL/hr. In response to the physician’s order, a pharmacy intern sent a two-liter bag of sterile water for injection up to the patient’s floor. The bag was then hung by the patient’s nurse despite the warning label stating “Not for Direct Infusion”. The patient received a total of 550 mL of sterile water intravenously before the warning was noticed and the infusion was discontinued. As a result of the profoundly hypotonic infusion the patient experienced a hemolytic reaction, acute renal failure, and ultimately died. This case illustrates that even water can be dangerous when given inappropriately.

    As a result of this case and reports of similar cases, ISMP has made several recommendations to help prevent the intravenous administration of sterile water from occurring at other institutions. It is important that practitioners have an understanding of the physiology behind infusing hypotonic, isotonic and hypertonic solutions in response to a patient’s electrolyte concentrations.

    The treatment of hypernatremia can be especially difficult in patients with co-mordid conditions that appear to limit therapeutic options. Guidelines should be established to aid in the treatment of hypernatremia in these complicated situations. It is important that practitioners recognize that the appropriate treatment of hypernatremia generally consists of infusions that contain some sodium. It is crucial that hypernatremia is corrected slowly in order to prevent cerebral edema from occurring. Any order that is received for the intravenous administration of sterile water should prompt an immediate call to the physician. In addition, ISMP urges that all large-volume parenteral bags of sterile water are stored in the pharmacy and are not available up on the floors.

    Please help educate fellow practitioners about the appropriate treatment of hypernatremia and the inherent dangers of infusing sterile water intravenously.

    References

    1. Even more about sterile water. ISMP Medication Safety Alert! 2003;8(6):3.
    2. How sterile water bags show up on nursing units. ISMP Medication Safety Alert! 2003;8(19):1-2.
    3. Water, water everywhere but please don’t give IV. ISMP Medication Safety Alert! 2003;8(2):1-2.
  • February 27, 2004 2:44 PM | Brad Miller (Administrator)

    Whether March is in like a lion and out like a lamb, or in like a lamb and out like a lion, Spring is just around the corner, which means WMSHP 35th Annual Spring Seminar. This year, past-president Jaci DeYoung is feverishly working to confirm speakers for the seminar. The seminar this year is May 6th at the Hilton Grand Rapids Airport. It will include a general session with a presentation on Emergency Medicine, and a review of the new community acquired pneumonia guidelines. The afternoon will offer three tracks to select from with three presentations within each. The tracks are categorized into technician, critical care and ambulatory care. The technician track will include presentations on vaccines, law review and math review. Ambulatory care track will include discussions on Alzheimer’s disease, cardiovascular and anticoagulation updates. The final track, critical care, will include presentations on proton pump inhibitors, prevention of venous thromboembolism and nutrition support in the critically ill. So mark your calendars for May 6th. I hope to see you there

  • February 27, 2004 2:44 PM | Brad Miller (Administrator)

    NSAIDs have gained popularity as a pediatric treatment for pain and fever. However, these drugs may still be associated with some important risks. In the March WMSHP newsletter, Renee Marana, Pharm.D., a Pharmacy Practice Resident at Bronson Methodist Hospital, writes of the use of NSAIDs in neonatal patients.

    ___________

    NSAIDs in Neonates: Are They Safe?

    Renee Marana, Pharm.D.

    ___________

    Pain and fever are common symptoms in neonates for which effective treatments are necessary.1 Neonates may experience pain after procedures or related to underlying conditions. Acetaminophen is often used first line to treat pain and fever, although physicians, nurses, and families often find the need for additional analgesics and/or antipyretics. This is usually when nonsteroidal agents are considered.

    The use of nonsteroidal anti-inflammatory drugs (NSAIDs) has become routine for adults and children in the management of pain, and NSAIDs have gained popularity for the treatment of fever secondary to the association of Reye syndrome with aspirin.1 NSAIDs are also commonly used in neonates for closure of patent ductus arteriosus. Although generally considered relatively safe agents, NSAIDs are not without their risks, especially when used during the neonatal period. Overall, there is a lack of data concerning the use of NSAIDs in the neonatal population for purposes other than closure of the ductus arteriosus.

    NSAIDs inhibit the cyclooxygenase enzyme, which leads to decreased synthesis of prostaglandins. Prostaglandins are important for the healthy development of neonates. They are involved in the development of numerous organ and physiologic systems such as the sleep cycle, cerebral blood flow, renal hemodynamics, thermoregulation, hemostasis, and the pulmonary, central nervous, and cardiovascular systems.1 There is evidence that the proper genesis of these systems may be adversely affected by NSAID exposure in utero and during the neonatal period.1

    Therefore, interfering with prostaglandin synthesis with the use of NSAIDs may expose the newborn child to unique developmental risks. There have been numerous reports of nephrotoxicity in neonates that were exposed to NSAIDs at an early age.3 Although indomethacin appears to have the most effect on renal blood flow, other NSAIDs, such as ibuprofen, are also associated with decreased renal function.4 When assessing the increased risk for bleeding, ketorolac has been associated with the most pronounced effect, although other NSAIDs also increase the risk of bleeding.2

    The NSAIDs are also associated with adverse effects on the gastrointestinal (GI) system, such as abdominal pain and ulceration. In response to adverse GI effects came the development of the cyclooxyenase-2 (COX-2) inhibitors. Although they are relatively safe to use in adults, safety and efficacy have not been evaluated in neonates. The COX-2 enzyme is also involved in the development of many organ systems, and its inhibition may lead to a prothrombotic state.1

    NSAIDs should be used cautiously in infants with underlying hepatic dysfunction, impaired renal function, hypovolemia or hypotension, coagulation disorders, thrombocytopenia, or active bleeding from any cause.2,3 It is important to be aware of the possible adverse reactions caused by NSAIDs so that proper monitoring can be performed and the agent can be discontinued, if needed.2

    When the need for an analgesic or antipyretic arises in the neonatal population, many factors must be considered before choosing a non-steroidal agent. Intermittent doses of a non-steroidal may at times be needed and appropriate, although regular scheduled use of these agents is usually not indicated. It has been stated that NSAIDs should be used with extreme caution in infants. Other agents, such as acetaminophen, and narcotic agents should be used preferentially for fever and pain. Neonates that do receive NSAIDs should be monitored closely for adverse effects on the kidneys, platelets, hemostasis, and other organ systems.

    References:

    1. Morris JL, Rosen DA, Rosen KR. Nonsteroidal anti-inflammatory agents in neonates. Paediatr Drugs 2003;5:385-405.
    2. Kokki H. Nonsteroidal anti-inflammatory drugs for postoperative pain: a focus on children. Paediatr Drugs 2003;5:103-23.
    3. Cuzzolin L, Dal Cere M, Fanos V. NSAID-induced nephrotoxicity from the fetus to the child. Drug Saf 2001;24:9-18.
    4. Pezzati M, Vangi V, Biagiotti R, et al. Effects of indomethacin and ibuprofen on mesenteric and renal blood flow in preterm infants with patent ductus arteriosus. J Pediatr 1999;135:733-8.
  • January 26, 2004 2:45 PM | Brad Miller (Administrator)

    February is the Michigan Pharmacy Association (MPA) Annual Convention and Exposition (ACE) in Dearborn. This year’s theme is Pathways to Positive Outcomes. The conference offers programs for pharmacists, technicians and students.

    As is previous years, WMSHP will be participating in the MPA Leadership Breakfast scheduled Saturday morning during the ACE. The breakfast meeting theme will revolve around membership retention and recruitment. The WMSHP members that will be representing you are Jeff Van Houten, Jesse Hogue and Vicki Sternhagen. Also, there is the MPA house of delegates session at the ACE. WMSHP this year is entitled to four delegates. Your 2004 delegates are Jeff Van Houten, Jesse Hogue, Brad Miller and Jean Lee. The alternative delegate is Vicki Sternhagen. The delegates will identify issues and policies to be considered by the Executive Board, and consider bylaw changes. Please contact any of the above representatives with topics or ideas that you would like discussed at their meetings.

    New this year at the MPA ACE meeting is a session that will be conducted by pharmacy students. Each College of Pharmacy will have one student presenting. The student representing Ferris State University is Sheila Duffy. Her presentation is entitled “The Use of Alternative Medicines in Type 2 Diabetic Patients: Panacea, Placebo or Poison?”. Specifically, Sheila will be discussing the affects of chromium and ginseng in type 2 diabetes and providing recommendations for their use in therapy.

    I hope to see some of you at the MPA ACE meeting Dearborn and the WMSHP meeting in Kalamazoo this month.

  • December 23, 2003 2:45 PM | Brad Miller (Administrator)

    Happy Holidays! I hope you are all enjoying the Holiday season.

    January is the time of year that we induct our new officers. This year we have several changes to the Board. Specifically, we have three new members that I would like you to get acquainted with, Brad Miller, secretary and Jodie Bakus and Vicki Sternhagen as Board members. We also welcome Jody Mehren back to the Board for a second term.

    Brad Miller is Director of Inpatient Pharmacy Services at Pennock Health Services in Hastings. He received his Pharm.D. degree from Ferris State University. In 2003, he completed a pharmacy practice residency at Spectrum Health. Also, Brad is the designer and webmaster of the WMSHP website. He as done an outstanding job creating the website and maintaining it. Please check it out at www.wmshp.net.

    Jodie Bakus is an Assistant Professor of Pharmacy Practice at Ferris State University. She received her Pharm.D. degree from Ferris State University. Following graduation, she completed a community pharmacy practice residency sponsored by Meijer Pharmacy, Ferris State University and Pfizer. She has practiced community pharmacy in the chain and the independent setting where she participated in patient care activities including: diabetes education, immunizations, hyperlipidemia screening, and a pharmacy-based anticoagulation clinic.

    Vicki Sternhagen is originally from Atlantic Mine, Michigan; a small copper mining town in the Upper Peninsula. She received her Pharm.D. degree at Ferris State University. After graduation, she moved to Madison, Wisconsin to complete a pharmacy practice residency at Meriter Hospital. Vicki is currently an Assistant Professor of Pharmacy Practice at Ferris State University. Her practice site is located at Borgess Medical Center with a focus on internal medicine. Her main interests are in cardiology and nutrition.

    On behalf of the WMSHP board, I would like to thank Jaci DeYoung for her service as president, and Tracey Mersfelder as Board member. Especially, I would like to thank Lisa DeVries for her eight years of service as secretary to WMSHP. Thanks for all your hard work and dedication.

    I hope to see you at the January meeting where we will be inducting the new members. Please feel free to contact myself or any of the board members with ideas you may have for meetings, topics you would like discussed in the newsletter or current issues to be posted on the website. Thanks for the opportunity to serve as WMSHP President.

  • October 24, 2003 2:46 PM | Brad Miller (Administrator)

    Elections – 2003
    Thanks to all of you for taking the time to vote for our new Board Members – we had a great response! Congratulations to the following:

    President-Elect:
    Jean Lee, Saint Mary’s Mercy Medical Center, Grand Rapids

    Board Members:
    Jodi Bakus, Ferris State University, Kalamazoo
    Mitzi McGinnis, KCMS – Ferris State University, Kalamazoo
    Jody Mehren, Saint Mary’s Mercy Medical Center, Grand Rapids
    Vicki Sternhagen, Ferris State University, Kalamazoo

    Secretary:
    Brad Miller, Pennock Hospital, Hastings

  • October 24, 2003 2:45 PM | Brad Miller (Administrator)

    WMSHP's second annual residency showcase was a great success with 11 programs and institutions participating. There were many Ferris students in attendance and it was great to see such interest in residency training. There were even P1's asking about specialty residencies! It's never too early to investigate career opportunities and it was wonderful to see students so early in their education thinking so far ahead.

    On behalf of the WMSHP board, I would like to congratulate Joan Rider, PharmD on her selection as honorary member. Joan currently serves as President of MPA and has a long history of involvement in professional organizations, including WMSHP. As honorary member, Joan will receive a lifetime of paid dues to WMSHP.

    I would also like to congratulate the recently elected board and thank all of our members for voting. We will be formally inducting new officers at the January meeting.

    The vote for the by-law revision limiting the associate member status to students was passed by a vote of 25 to 1. Thank you for taking the time to vote at the October meeting.

  • June 20, 2003 2:47 PM | Brad Miller (Administrator)

    CMS (Centers for Medicare and Medicaid Services) had again changed the response date for their proposed re-classification of pharmacy residency programs to continuing education programs, thus not eligible for Medicare "pass-through" dollars. On Monday, the date for response was moved back to the original date, July 8, 2003. CMS justifies this policy change because not all pharmacists that work in hospitals are required to complete a residency program. CMS further argues that residency programs are "continuing education," comparable to seminars and workshops, since they do not lead to "specific certification in a specialty." Continuing education programs are treated as normal operating costs included in the prospective payment rate.

    This change will go into effect on October 1, 2003 UNLESS YOU ACT by July 8. Residency preceptors, current, future and past pharmacy residents, administrators, physicians and patients should write CMS concerning the value of pharmacy residencies and their impact on direct patient care. For more information and a complete description of the issues, please go to the ASHP Residency and Accreditation Information webpage, http://ashp.org/rtp/index.cfm?cfid=20280037&CFToken=7632685 or directly to the information page describing the CMS action and what you can do: http://ashp.org/rtp/writecms.cfm?cfid=20280037&CFToken=7632685.

  • April 01, 2003 2:47 PM | Brad Miller (Administrator)

    I recently received a videotape from ASHP entitled "Translating National Goals into Local Action". The videotape is narrated by Debra S. Devereaux, MBA, FASHP, President of ASHP. The 10 minute video describes ASHP's progress on the 6 planks of the Society's 2002-03 Leadership Agenda. Although ASHP's intent is to play the video during one of our meetings, I felt that this would be difficult due to the availability of equipment and time constraints. Therefore, I have summarized the main points below.

    The 2002-2003 Leadership Agenda formally communicates ASHP's organizational priorities and serves as a framework for future activities. The six major planks of the Agenda are listed below with the progress to date indicated as indented bullet points.

    Foster fail-safe medication use in health systems.

    • Center for Patient Safety provides CE, comprehensive website, strategic alliances, and supports barcoding.
    • Medication safety officer job description available on ASHP's website.
    • Expand access to the patient-care services of health-system pharmacists.

    Support Medicare and Medicaid provider status for pharmacists. 

    • Public relations initiative with pharmacy directors to convey pharmacists' unique roles to the public (publicinfo@ashp.org).
    • Collaborative Drug Therapy Management authority in 34 states

    Help health-system pharmacists deal with the affordability and accessibility of pharmaceuticals.

    • "Drug-cost technique" checklist being developed.

    Foster an adequate supply of practitioners and practice leaders in health-system pharmacy.

    • New section of Pharmacy Practice Managers
    • Advocated federal support for pharmacy training and education
    • Foster expansion of residency training
    • New virtual mentoring program instituted

    Close the gaps in health-system pharmacy emergency preparedness.

    • Advocate that pharmacists be involved at all levels of emergency preparedness planning
    • Close drug supply chain gaps
    • Counterterrorism website and CE
    • Assist Public Health Services
    • Recruit pharmacist volunteers to participate in chemoprophylaxis and mass vaccination if needed

    Accelerate efforts to help health-system pharmacists prepare for advances in science and technology.

    • Section of Clinical Specialists and Researchers to provide input.
    • Establish genetics resource center
    • Provide CE in the areas of genome project, nanotechnology, genomics, and immunomodulation

    For more information, please visit www.ashp.org

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