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[Original publication date 7/5/2024] Diversion management starts before a new staff member walks in the door. It is looking for red flags, even before any access to medications is given. It starts before any staff is hired and can be before an interview is offered. Most hiring managers assume that the human resources team is doing their due diligence to monitor for potential issues that may arise, but without asking questions and knowing the process, it is possible that expectations do not meet reality. In addition, we assume that licensing boards are also watching for possible risk factors, but many of us have not reviewed the business and professions code related to licensing and possible loss of license, which may not factor in every misdemeanor charge.
To start from the beginning means that the pharmacy diversion lead needs to meet with human resources to define a set guideline for onboarding any new employee. This information should be shared with your diversion committee or group, and guidelines should be created for screening new hires. This includes “deal breakers,” for example a Driving Under the Influence (DUI) or other charge related to alcohol, illegal, or dangerous drugs within the last 3 years, regardless of felony or misdemeanor status.
This may also mean training human resources staff on how to properly review a professional license, including any public documents and the charges to the applicant by the board. Knowing the issue and the timeline of events better allows the hiring manager to make an educated decision on hiring, and/or can allow the diversion team to better monitor those at a higher risk. For example, a recent hire had public documents about past diversion and substance abuse treatment at a prior facility. This was not discovered until possible diversion occurred at the current facility. The knowledge of the past diversion would have helped decrease the risk to the new institution, the staff member, and most importantly the patients he was treating.
If the decision is made to hire a licensed staff member, prior to giving them access to automated dispensing machine (ADM), the system access request should require the staff member to acknowledge their risk of diversion. This includes asking questions regarding past infractions, but also asking about any current or pending investigations at previous facilities and/or within other localities or states. It is also important to identify the system access request form as a legal document, so that should a new staff member choose to put inaccurate information on the form, termination can be considered.
The system access request form allows the diversion team and the pharmacy informatics team to capture individuals at high risk who may have not been identified by human resources. For example, an employee may have been hired but while waiting to be onboarded was arrested for a DUI, or an employee recently left an institution after being placed under investigation for diversion but with a licensing board that is only starting the investigation process.
In summary, diversion management is not just what is occurring within the walls of the institution. It starts when a person applies to your facility. It is critical to research all avenues for areas of concern, and to ask important questions and understand the current licensing and onboarding process. It is every member of the team’s responsibility to ensure that the staff, facility, and patients are at the lowest risk possible.
[Original publication date 9/3/2024] - Pharmacy technicians are the backbone of successful pharmacy operations. In health system inpatient pharmacies, they handle complex tasks such as sterile compounding, inventory management, controlled substance security, automation oversight, and handling of hazardous medications. They work tirelessly behind the scenes to ensure patients receive safe and quality pharmaceutical care. The ongoing shortage of qualified pharmacy technicians is a significant barrier to progress in an evolving healthcare landscape in the era of technological revolution.
Pharmacy design is evolving, driven by advancements in technology, a deeper understanding of workflow optimization, and an increased focus on medication safety and staff well-being. The future of pharmacy design depends on a comprehensive approach that integrates state-of-the-art technology, ergonomic principles, and a patient-centered mindset. This article explores the trends and key considerations shaping the pharmacy of tomorrow, highlighting how strategic design improvements can enhance efficiency, ensure safety, and improve patient outcomes.
In hospital settings, medication reconciliation stands as a cornerstone in patient safety efforts, ensuring accurate medication histories and preventing adverse drug events. Pharmacy technicians play a pivotal role in this process, offering indispensable support to pharmacists and healthcare teams. As hospital pharmacy leaders and executives navigate the complexities of healthcare delivery, harnessing the full potential of pharmacy technicians in medication reconciliation becomes paramount for optimizing patient outcomes and operational efficiency.
VIDEOS
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Michele Shaeffer, Associate Director of Pharmacy Operations at Jefferson Abington Hospital, shares insights on optimizing pharmacy workflows amidst staffing and medication shortages, highlighting automation and ADC cabinets for improved efficiency and safety. She also emphasizes cross-department collaboration and staff training as essential for addressing these challenges. Looking ahead, she sees innovations in legislation, technology, and industry-wide collaboration as key drivers of progress in tackling systemic issues like drug shortages.
In this week’s Executive Insights video Jeff Thompson, Chief Clinical Officer at Freeman Health, shares insights into the evolving role of pharmacy leadership within health systems. Thompson highlights the importance of aligning pharmacy goals with broader C-suite objectives, recognizing pharmacy not only as a significant expense but also a substantial revenue driver. He also addresses current challenges, such as labor shortages and the impact of 340B contract pharmacy restrictions, which are shaping strategies for sustaining healthcare operations.
In this insightful interview, Alex Kardos, Corporate Director of Pharmacy Services at RX Holding Hospital, discusses his role overseeing pharmaceutical operations across 126 sites. He highlights the challenges of navigating regulatory pressures, drug shortages, and staffing issues while emphasizing the growing importance of driving revenue in outpatient settings. Kardos shares how his team balances these demands by leveraging peer insights and vendor partnerships to improve efficiency and compliance.
Dr. Rabiah Dys, Senior Vice President of Clinical Services and Program Development at CPS, shared insights at ASHP on her role and passion for advancing health equity. She emphasized the importance of improving health literacy by helping patients understand their diagnoses and care plans, starting at hospital admission. Dr. Dys also highlighted the need for better continuity of care between hospital discharge and community pharmacy settings to ensure patients can manage their health effectively.
Industry News
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BRONX, N.Y. - A new study led by researchers at Albert Einstein College of Medicine involving more than 200,000 adults found that the COVID-19 pandemic caused a 29% increase in risk for developing dyslipidemia, a condition involving abnormal lipid (fat) levels in the blood. Seniors and people with type 2 diabetes were even more strongly affected, experiencing an approximately two-fold increased risk for developing dyslipidemia, which is a major risk factor for cardiovascular diseases such as heart attack and stroke. The research was published today in the print edition of The Journal of Clinical Investigation.
"Given the extent of the pandemic, this increase in dyslipidemia risk is a cause for concern around the world," said study leader Gaetano Santulli, M.D., Ph.D., associate professor of medicine and of molecular pharmacology at Einstein. "Based on our findings, we would advise people to have their lipid levels monitored regularly and to consult with their healthcare providers about ways to treat dyslipidemia if detected, especially elderly individuals and patients with diabetes." He noted that this advice would apply to all adults, not just those formally diagnosed with COVID-19, considering that many people have been infected without realizing it.
To put these findings into context, it has been estimated that 53% of U.S. adults had dyslipidemia before the pandemic; a 29% increase in dyslipidemia incidence due to COVID-19 would mean that 68% of Americans may now be at risk for having lipid abnormalities.
In two previous studies, Dr. Santulli and his team found that COVID-19 raised the incidence of new cases of hypertension and type 2 diabetes. "In those analyses, we demonstrated that the risk of developing these disorders was still high three years after the pandemic; moreover, we noticed a suspicious increase in total cholesterol levels, which warranted a closer look," said Dr. Santulli. In the new study, the researchers first determined the incidence of dyslipidemia in a group of more than 200,000 adults living in Naples, Italy during the three years prior to start of the pandemic (2017-2019). They then assessed the incidence of dyslipidemia in the same group during the three-year COVID-19 period (2020-2022), excluding from the analysis those people earlier diagnosed with dyslipidemia or who had previously been taking lipid-lowering medications.
The investigators found that COVID-19 raised the risk for developing dyslipidemia in the entire study group by an average of 29%. The increase was even higher among people over age 65 and those with chronic conditions, particularly diabetes and obesity, cardiovascular disease, chronic obstructive pulmonary disease, and hypertension. The findings are the most definitive to date because other studies—most of them linking COVID-19 with modestly increased risks for blood-lipid problems—used as control groups different populations or people thought to have gone through the pandemic without becoming infected. However, significant numbers of people classified as "COVID-free" actually developed the disease but were either never tested or didn't seek medical care.
"Our study did not attempt to determine whether participants had tested positive for COVID-19," Dr. Santulli said. "Instead, because we had been following this group for many years prior to the pandemic, we were able to measure COVID's overall impact on the population by simply comparing levels of dyslipidemia in the same group before and after the pandemic. Any increase in dyslipidemia incidence would almost certainly have to be the result of COVID-19."
How COVID-19 might have increased the incidence of dyslipidemia remains unclear. One possible explanation is a finding Dr. Santulli made in an earlier study: that SARS-CoV-2 (the virus that causes COVID) disrupts the function of endothelial cells, which line the inside of blood vessels throughout the body and play a critical role in regulating blood lipids.
A separate study found that COVID-19 is a powerful risk factor for heart attacks and strokes for as long as nearly three years after an infection. "This investigation, published online a month after ours, essentially confirms our observations in this study, since dyslipidemia is a major contributor to cardiovascular disease," said Dr. Santulli. "It also suggests that tackling dyslipidemia should reduce the risk of cardiovascular disease in those who have had COVID."
The researchers are now studying the effects of COVID-19 on cardiovascular-kidney-metabolic (CKM) syndrome, a recently described condition involving four connected medical problems—heart disease, kidney disease, diabetes, and obesity—all of which involve endothelial dysfunction.
The study is titled "A six-year study in a real-world population reveals an increased incidence of dyslipidemia during COVID-19". The other contributors include: Stanislovas S. Jankauskas, Ph.D., and Fahimeh Varzideh, Ph.D., both at Einstein, Pasquale Mone, M.D., Ph.D., at Einstein and Molise University, Campobasso, Italy, Valentina Trimarco, Raffaele Izzo, Maria Virginia Manzi, Maria Lembo, Paola Gallo, Giovanni Esposito, and Francesco Rozza, at the Federico II University of Naples, Italy, Roberto Piccinocchi, at the Vanvitelli Hospital, Naples, Italy, Carmine Morisco and Bruno Trimarco, at the International Translational Research and Medical Education (ITME) Consortium and Federico II University of Naples, Gaetano Piccinocchi, at the Italian Society of General Medicine, Mario Fordellone and Giuseppe Signoriello, at the Campania University, Naples, Italy.
COVINGTON, KY - Bexion Pharmaceuticals, Inc., a clinical-stage biopharmaceutical company developing a novel class of biologic therapy to treat advanced solid tumors and chemotherapy-induced peripheral neuropathy (CIPN), announces the publication of first-in-human data from a Phase 1 study of BXQ-350 in Clinical Cancer Research, an American Association of Clinical Research (AACR) journal. The study showed that BXQ-350 was well-tolerated with no dose-limiting toxicities. BXQ-350 is currently being studied for the first line treatment of metastatic colorectal cancer (mCRC).
The U.S. Food and Drug Administration (FDA) approved revumenib on November 15, 2024, for relapsed or refractory acute leukemia with a KMT2A translocation. This marks a significant development in cancer treatment, as the drug, first administered to a patient at Florida Cancer Specialists & Research Institute, LLC (FCS) in 2019 during a Phase 1 clinical trial, is now accessible nationwide.
INDIANAPOLIS, IN - Eli Lilly and Company announces positive Phase 2 results for muvalaplin, an investigational once-daily, orally administered selective inhibitor of lipoprotein(a) [Lp(a)], a genetically inherited risk factor for heart disease. The study demonstrated that muvalaplin significantly reduced elevated Lp(a) levels in adults, meeting its primary endpoint of percent change in Lp(a) from baseline to week 12.