excelleRx Highlights Hospice Pharmacia

14 volume 3 | issue 2
Passionate for the Appropriate Use of Medication
Passionate for the Appropriate Use of Medication
volume 3 | issue 2
1
National
Security Issues
Thank you for the many calls and
notes we have received as a result
of our information-sharing during
times of national homeland
security code orange alert. We
would like to extend a special
thanks to our Partners who have
taken the steps along with us to
protect patients and staff during
this time of world tension. For any
Partner who would like more
information regarding the HP
business interruption plans, please
contact Stephanie Zarus, PharmD,
Chief Performance Officer x1609,
szarus@excelleRx.com.
excelleRx, Inc.
P.O. Box 40075
Philadelphia, PA 19106
HPRxCard Survey
continued from page 11
Affairs department to support
adjudication needs of the
local pharmacies (dial 877-882-
7820, press 1, then press 4)
• Piloting a fax communication
project to deliver prescription
information directly to the local
pharmacy along with necessary
billing information to smooth
prescription processing
Other comments we received were
regarding Xeris on-line tools—
respondents requested features
like electronic prescribing and
electronic renewal of prescriptions,
as well as on-site training
and electronic training. We are in
the process of perfecting electronic
prescribing, and we hope
to deploy this by December 2003.
Regarding Xeris training, HP
offers at least one (sometimes
two) Xeris training webconference
per month. Xeris
training is also available during
implementations and reimplementations.
If you are
interested in being trained on
Xeris, and are unable to attend
our web-conferences, please
contact Laura Lutz at 215-282-
1664.
Thank you again for participating,
and keep looking for the next
opportunity to win!
excelleRx Highlights Hospice Pharmacia
n e w s l e t t e r a publication of excelleRx, Inc.
Pharmacotherapy’s Emerging Sweet
Spot: Quality through Evidence
–Calvin H. Knowlton, RPh, MDiv, PhD, CEO
As we help catalyze the shift from
preference-based prescribing to
evidence-based prescribing, the
notion of quality within
pharmacotherapy becomes paramount.
We are very pleased to use
this edition’s column to describe our
current initiatives relating to the
gathering, documentation, and
harvesting of an array of
pharmacotherapy-related quality
indicators. The indicators we
developed are segmented into the
following categories: economic,
clinical, and humanistic. Costappropriate
medication use metrics
fall naturally into these three
domains.
Gathering Data—inputting information
about the patient, the
medications, the results.
Once we have the patient demographics,
including diagnosis, and
the medication care plan (related
and unrelated meds with attached
indications), the critical third link is
the medication-related results.
There are two main portals of entry
into this portion of our quality
labyrinth. First, every one of the
>3,500 daily incoming calls to our
two Pharmaceutical Care Support
Centers (Philadelphia and Phoenix)
provides an opportunity to assess
results. In the clinical category, we
inquire about the patient’s pain level
and bowel status. Shortly we will
add anxiety, nausea, dyspnea, and
tiredness as other clinical endpoints.
In the humanistic (or quality of life)
category we inquire regarding the
level of interaction with family.
Soon we will add quality of sleep,
appetite, and general quality of life
as additional outcome indicator
metrics.
Second, access to our economic,
clinical, and humanistic information
gathering process is also available via
the web (Xeris) and our touch-tone
telephone system we call RoMEO
(Related Measures of Endpoints and
Outcomes).
Documenting Data—storing information
about the patient, the
medications, the results.
We utilize new, very robust
technology to house our secure data.
We have real-time redundancy with
“connected” servers in our Philadelphia
and Memphis sites.
Regardless of the portal of entry—
phone, web, IVR—all information is
stored safely in these redundant,
relational, and scalable servers.
Harvesting Data—integrating information
about patients, medications
and results.
In re-creating Version 5 of the
MUGs, we were able (for the first
time) to probe our extensive
palliative care database for evidence
regarding the use of medication at
the end of life. This is the first babystep
we achieved toward our realtime
Predictive Pharmacotherapy
Outcomes System (PPOS) that will
enable the instantaneous probing of
the database before finalizing the
medication portion of the care plan.
In other words, PPOS will permit all
of us to optimize the selection and
use of medication for an individual
patient based upon evidence.
Cost-appropriate medication use
goes beyond the comparative pricing
of similar medications. Selecting the
lowest priced drug in a class of
medications is a form of costminimization
that assumes all
compared medications produce the
same results, regardless of patientspecific
circumstances. excelleRx’s
cost-appropriate pharmacotherapy
plan invokes price plus access to
real-time evidence assessing
comparative results in like patients.
Documented quality trumps
preference as the sweet spot for the
medication portion of the care plan!
In This Issue
MUGs Summary
Technology Update
HP Definitions
excelleRx Institute
Marketing Update
Upcoming Conferences
Clinical Notes
HP Operations Update
HIPAA News
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www.excellerx.com

2 volume 3 | issue 2
Passionate for the Appropriate Use of Medication
Passionate for the Appropriate Use of Medication volume 3 | issue 2 13
Medication Use Guidelines,
Version 5: A Brief Primer
–Douglas J. Weschules, PharmD, Director of Clinical Services
It’s that time of year again!
Hospice Pharmacia is working
furiously towards the release of
MUGs Version 5, and we want to
give you, our hospice partners, a
peek at some of the changes that
are forthcoming. We are thrilled
with the collaborative efforts of
both our external and internal
review teams this year! We thank
these wonderful nurses,
pharmacists, physicians and
administrators. You will soon see
what a difference they have made!
Aside from an exciting new look,
the first major change that you
will notice is a shift from a
medication list format toward the
algorithmic layout. The intent of
this change is to make the MUGs
more useful to clinicians in the
field. The protocols that have this
new approach include:
• Nausea and vomiting--based on
suspected etiology
• Dyspepsia--based on dyspepsia
type
• Secretions--based on thickness of
secretions
• Pruritus--based on topical or
systemic therapy
• Insomnia--based on presentation
of insomnia
• Cachexia--based on co-morbid
conditions
• Skin/skin structure infections--
recognition of fungating tumor
therapy as separate
• Genitourinary infections--based
on whether UTI is
uncomplicated or complicated
• Fever (new)
Also, there are many noteworthy
additions to the MUGs protocols:
• Erythromycin for the treatment
of motility-related symptoms
• Famotidine (Pepcid®) for
dyspepsia and GI related disorders
• Misoprostol (Cytotec®) for the
prevention of NSAID induced GI
conditions
• Rabeprazole (Aciphex®) as an
alternate PPI choice for cancerrelated
GI conditions
• Doxazosin (Cardura®) for dysuria
and other genitourinary symptoms
for patients with a primary
diagnosis of prostate cancer
• Risperidone (Risperdal®) as a
2nd line agent for the treatment
of delirium/dementia and 1st line
therapy for the management of
sundowning
• Lisinopril (Zestril®, Prinivil®) as
an alternate ACE inhibitor choice
for cardiac diagnoses
• Salmeterol (Serevent®) added as
a treatment option for
COPD/pulmonary malignancy
patients
• Hydroxyzine pamoate (Vistaril®)
for nausea, anxiety, itching,
insomnia
• Cholestyramine (Questran®) for
itching related to hepatic
disease/jaundice
• Beclomethasone diproprionate
(Qvar®) for dyspnea, and COPD
continued on page 9
XerisHospiceAdministrator:
Secure UserID/Password Distribution Process,
to Assuring HIPAA Compliance
–Heather K. Omlor, PharmD, VP, Client Development
HP is pleased to announce the
launch of XHA, XerisHospice-
Administrator. This new Xeris
functionality was developed to refine
the Xeris access process and to
assure HIPAA compliance for both
HP and for our Partners.
Although, the final HIPAA Privacy
Rule does not require healthcare
organizations to encrypt electronically
transmitted health data, it
does request a determination
regarding the use of encryption as a
means to protect transmitted
protected health information (PHI).
excelleRx recognizes that e-mail
generated outside of our firewall is
not a secure form of transmitting
PHI because we cannot guarantee
that the personal e-mail account
holder is the only person accessing
this information. Therefore, we have
adopted polices that control the
methods in which personal and
confidential information will be
transmitted and to whom.
Xeris permits hospice personnel
(nurses, administrators, medical
directors) to create, obtain, use or
disclose PHI through secure
electronic transmission between the
user and HP. Our policies and
procedures were developed to ensure
that the process and responsibility
for requesting new access codes,
modifying existing codes, editing
passwords and validating users is
shared with your hospice and meets
HIPAA regulations.
To share responsibility of securing
your patients’ PHI, Hospice
Pharmacia has created Xeris-
HospiceAdministrator (XHA). XHA
enables a designated employee of the
hospice, to be identified as the
account administrator and to be
Taking Extra Steps on Privacy:
Security Contact Identification Program (SCIP)
To assure patient privacy under
HIPAA, HP will be launching a
contact identification program
during the second quarter of
2003. When anyone uses the web
(Xeris), he/she is prompted for
user identification and password.
This same type of security will
now be applied to HP’s telephone
system. Soon, when you
initiate any type of contact with
HP (telephone, web, and automated
telephone systems) you
will be prompted for your
security contact ID. This
enhancement is being added to
ensure privacy of health information
and control over automated
dispensing.
Other Benefits of SCIP
In addition to added security of
protected health information and
medication access, your hospice
responsible for activating, deactivating,
and editing hospice employees’
Xeris access codes.
Controlling Xeris access within the
hospice further secures the transmission
of PHI and complies with
the HIPAA Privacy Rule. Generating
Xeris codes within the hospice
limits the number of people who
come in contact with an individual’s
confidential information.
Helpful Hint: Every hospice should
assign a ‘back-up’ administrator to
manage Xeris passwords through
XHA in the event that the primary
administrator is unavailable.
Hospice Pharmacia will give your
primary administrator an access
code for XHA. For additional information
or questions, please contact
Mark Schreiber at 215.282.1636 or e-
mail xerispw@excellerx.com
HAVE YOUR I.T. DIRECTOR
or HIPAA OFFICER SIGN UP
TODAY!
will enjoy the following benefits:
• SCIP numbers will serve as
passwords to access HP’s online
pharmacy services (Xeris).
• Utilization reports from HP
can provide data segregated by
nurse.
• Nurses will be linked to patient
cases allowing continuity of
care documentation.
• Control over diversion of
products based on
unauthorized contacts.
More information on SCIP will
be conveyed to you soon!
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12 volume 3 | issue 2
Passionate for the Appropriate Use of Medication
Passionate for the Appropriate Use of Medication volume 3 | issue 2 3
JCAHO Survey
Scheduled
July, 2003
Over the next few months expect to
hear quite a bit of JCAHO chatter
from HP—we are currently
undergoing our ‘mock survey’ and
expect to have our official survey in
July, 2003. As many of you know,
HP has always operated under the
JCAHO standard, but we were not
eligible for review as a pharmacy
provider until just recently. We
look forward to having the seal of
approval for what we have been
doing all along!
Hospice
Pharmacia’s
Web Privacy
Information
excelleRx, Inc. respects the privacy
of all users of our websites. We
want you to make the most of our
internet-based services and to feel
confident while doing so. Our
policy regarding user privacy is
simple: we collect no private,
personal information unless it is
voluntarily supplied.
As you know, in 1996, the Federal
Government enacted the Health
Information Portability and
Accountability Act (HIPAA). This
Act governs access, privacy, and
HIPAA News
HIPAA News
transmission criteria for electronically
stored and transmitted
health information data. excelleRx
complies with HIPAA regulations.
Xeris users may have access to
protected health information
("PHI"), thus you must:
• Secure your access codes;
• Take precautions to protect your
access code and the PHI available
to you;
• Know and respect the rights of
patients regarding the privacy of
their health information;
• Recognize it is a criminal offense
to sell, transfer, or use PHI for
any purpose other than the
provision of patient care and
related services.
When you visit our sites, we do
not collect any personal information
without your consent. If
you have not willfully submitted
your personal information to us,
none is collected. From time to
time our site requests information
from users via surveys or registration
forms. Participation is
completely voluntary, and the user
therefore has a choice whether or
not to disclose his/her information.
We use physical, electronic, and
managerial procedures to protect
the personal and private health
information we collect. Encryption
tools are used when
collecting or transferring sensitive
infor-mation such as social
security and prescription
numbers. Additional database
content is protected by our
firewall and/or by encryption.
Presently, we do not rent, sell, or
otherwise share user personal
information or patient health
information with any third party.
Patient health information is used
strictly to provide patient care and
affiliated functions. By registering
as a Xeris user, please recognize
that occasionally you may receive
user-related information by mail,
e-mail or other transmission
methods from us.
excelleRx, Inc. aims to keep your
personal information as accurate
as possible. As a Xeris user, we may
contact you regarding any status
changes in your personal information.
To modify your contact
information or to remove your
name from our list of registrants
please send an e-mail request to
xerispw@excellerx.com specifying
your status change.
We are committed to protecting
your privacy and the privacy of the
health information for the patients
we serve. To view our privacy
state-ment in its entirety, please
click on the “excelleRx privacy
statement” link on the bottom of
any of our webpages.
Copyright © 2003, excelleRx, Inc.
Xeris, Predictive Pharmacotherapy
Outcomes System (PPOS),
ComfortPak, Medication Use
Guidelines (MUGs), and all Xeris
products and their respective logos
are Trademarks of excelleRx, Inc. All
rights reserved. No part of the
information contained herein may
be reproduced, duplicated, or
copied without permission. Please
inquire if you are not sure. PPOS
and Xeris are Patent Pending.
Technology
UPDATE
XerisConnect –
Let’s share…
–Joseph Filippoli,
VP of Information Technology
XerisConnect is yet another offering
in the Xeris suite of products.
XerisConnect is the name given to
the electronic interfaces between
Hospice Pharmacia’s systems and
your hospice software applications.
XerisConnect interfaces provide a
timely, accurate method of sharing
critical patient information. Patient
admissions, discharges, demographics,
status, team changes,
physician relationships, ICD-9
diagnoses, allergies and interactions
are exchanged between the two
systems without the need for timeconsuming
and potentially errorprone
human intervention or
duplicate data entry. Patient
medication profile-related data and
historical medication dispensing
information can also be electronically
interchanged. All of this
happens in real-time or “near realtime.”
With XerisConnect, your hospice
can expect to have shorter telephone
encounters for new patients. When
your nurses call our Pharmaceutical
Care Support Center, their patients’
demographic data is already in HP’s
system, so they are routed directly to
a pharmacist for medication care
planning. This eliminates verbal
collection of patient demographic
data by an HP pharmacy technician,
and saves a few minutes per nurse
per call.
In addition, you can expect reduced
delivery errors (because of increased
accuracy of address information),
faster turnaround of HPRxCard
activation, more complete diagnosis
information, and easier reconciliation
of month-end billing
reports.
All data is transmitted securely
between your systems and ours, in
compliance with HIPAA regulations.
XerisConnect is currently operational
with Suncoast Solutions,
Mills & Murphy’s HPMS, and Misys
Visions. Many other interfaces are
currently under development or are
planned for development in the near
future. If you do not see the name
of your hospice software application
please contact your vendor or Joe
Filippoli, VP of Information Technology
at 215-282-1622 to find out
more.
XerisConnect saves time,
improves accuracy, reduces
errors and increases efficiency
for our Hospice Partners!
XerisBilling
As we go into month three of
XerisBilling, we look forward to
hearing from you regarding your
interest in continuing to receive
paper bills. Remember that after
April, you will be able to process
your entire bill on-line through
Xeris without a paper bill from HP.
If your hospice is eligible for an
early payment discount, consider
guaranteeing that you receive it by
establishing electronic transfer of
funds. For questions about
XerisBilling or to inquire about
electronic payment, please contact
Larry Driscoll at x1605, or
ldriscoll@excelleRx.com.
XerisATM
(Access to Medications)
Update
–Karen Jordan,
Technology Liaison
Hospice Pharmacia is pleased to
announce that we have successfully
completed the pilot of the
XerisATM and that we have several
implementations planned for the
2nd quarter of 2003 and beyond.
XerisATM for homecare enhances
emergency medication management
for a wide range of symptoms
by enabling an HP pharmacist to
electronically transmit a prescription
to a secure medication cabinet
within a hospice. XerisATM for
homecare units will soon be
implemented at hospices in Colorado
and Tennessee, and we are
making preparations for several
other units across the country.
XerisATM allows a hospice to
utilize HP’s medication management
services for patients in an
inpatient unit. Using similar
technology to the XerisATM for the
homecare setting, HP can provide a
secure source of medications
geared to the specific needs of acute
care patients in an institutional
environment. A recent survey has
shown that many of our hospice
partners currently have or are
planning an inpatient unit and
continued on next page
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4 volume 3 | issue 2
Passionate for the Appropriate Use of Medication
Passionate for the Appropriate Use of Medication volume 3 | issue 2 11
ARDS (Automated Refill/Discharge System)--The interactive voice response
system available via the telephone for routine refills and patient
discharges.
RoMEO (Related Measures of Endpoints and Outcomes)--Interactive voice
technology enabling the hospice nurse to document how the patient is
doing (symptom endpoints and quality of life outcomes).
MUGs (Medication Use Guidelines)--A system of evidence based, peerreviewed
step care guidelines and algorithmic protocols published
annually exclusively for hospice partners of Hospice Pharmacia.
Xeris--excelleRx's suite of on-line patient care tools.
XerisATM (Access To Medication)--Remote, secure, medication dispensing
cabinet for patients at home or IPU.
XerisBilling--On-line invoice for per diem hospices.
XerisConnect--Secure, electronic interface between Hospice Software and
Xeris.
XerisHospiceAdministrator--Enables the hospice to control the
distribution and administration of Xeris hospice user accounts.
XerisRxOversight (XRxO)--On-line access for referring physicians to
their patients' data and care plan oversight documentation.
XerisATM
Update
continued from page 3
would like HP to service those
patients. XerisATM for IPUs will
be piloted during the 2nd quarter
of 2003, and planning is already
underway with hospice partners
interested in implementing
inpatient services from HP.
For further information on either
of these options, please contact
Orsula Voltis Thomas, 215-282-
1602, Orsula@excelleRx.com or
Karen Jordan, 215-282-1658,
Kjordan@excelleRx.com.
HP definitions
Discharge
Options
–Laura Lutz, External Education
Coordinator
HP would like to remind our
hospice Partners that there are now
three ways to discharge patients
from HP’s system:
1. Using the ARDS (Automated
Refill and Discharge System)—call
our main number 1-877-882-7820
and choose option 1, then option 2.
You will need the patient’s social
security number or telephone
number. Follow the prompts to
complete the discharge.
2. Contacting the Pharmaceutical
Care Support Center—call our main
number 1-877-882-7820 and choose
option 1, then option 1. You will be
connected with a member of our
pharmacy staff. Please relay the
information to him or her verbally.
3. Through Xeris (our online
tool)—log on to Xeris from
www.hospicepharmacia.com, Select
the appropriate patient’s profile.
Click the “Discharge/Decease
Patient” button to the left of the
patient’s name, and select the correct
date and information. This can be
done anywhere at anytime securely
over the Internet—if you have
internet capabilities this may be the
best option for you. You can
perform discharges 24/7.
Please discharge patients in HP’s
system using one of the above
methods within 3 days of the
patient’s actual discharge date!
If you have any questions, we
welcome your participation in the
next Xeris web conference training
session. Please check the dates for
the next session in this newsletter or
on our website. If you have any
questions or comments, please call
Laura Lutz, External Education and
Implementation Coordinator at
x1664.
Please note: Discharging patients
is important! Your hospice is
financially responsible if a patient
is not discharged in HP’s system
Patient
Satisfaction
Survey Results
In early March, HP distributed
our annual patient survey in 2500
medication packages dispensed
from our Philadelphia and
Memphis sites. To date over 11%
of the surveys have been
returned. The results are
impressive, but not surprising—
thanks to the partnering efforts
of our hospices:
• 99% are satisfied with pharmacy
services provided by HP
• 92% report that their pain is
adequately controlled
• 90% received a Comfort Pak
• 98% are satisfied with the delivery
of their medication
• 100% state that the HP printed
prescription label is easy to read
• On the first day of hospice, 99% of
patients were told about Hospice
Pharmacia’s services and that
medications would be delivered
directly to their doors
In addition,
• 25% would be willing to document
pain and symptom scores via
secure interactive telephone system
• 20% would like to refill their own
hospice prescriptions, either by
telephone or the Internet.
We will be using the data from these
surveys to assess current services and
create new initiatives to assure high
patient satisfaction. If you have ideas
for survey questions, please contact
Stephanie Zarus, PharmD, Chief
Performance Officer at x1609 or at
szarus@excellerx.com.
Our Nurse Satisfaction Survey will be
released this May. We encourage you
to participate to enable us to
continue to build our services around
wants and desires of our clients!
HPRxCard
Survey
Thank you to everyone who
participated in our HPRxCard
Survey! Congratulations to hospice
nurse Rhonda Shales for being the
randomly chosen winner of a $100
Amazon gift certificate—just for
filling out the survey!
Your comments are valuable to us.
Many of you expressed that you are
satisfied with our HPRxCard
processes. When we asked how we
could improve our services, the
remark that appeared most
frequently was that the local
dispensing pharmacies need more
education about hospice and
meeting the medication access
needs of hospice patients.
We at HP are currently doing the
following for your local
pharmacies:
• Broadcasting communications
regarding the importance of
planning for business interruption
and the necessary hospice meds
they should have at all times
• Staffing a full service Pharmacy
continued on page 14
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10 volume 3 | issue 2
Passionate for the Appropriate Use of Medication
Passionate for the Appropriate Use of Medication volume 3 | issue 2 5
HP Operations
UPDATE
Commonly Asked Questions about
HP’s CII Opioid Analgesic Rx
Reconciliation Process
–Stephanie Zarus, PharmD, Chief Performance Officer
Nursing staff and physician offices
frequently inquire about Hospice
Pharmacia’s policy for controlled
substances (CII) prescription
reconciliation. This article explains
this process and how HP
supports our hospice partners to
assure medication access within
State and Federal Guidelines.
What is the CII Authorization
Process at HP?
HP recognizes the hospice nurse as
the primary health care professional
managing the patient's care plan.
An HP pharmacist works with the
hospice nurse to manage the
medication portion of the care plan.
The nurse is responsible to present
the care plan to the physician for
approval. The nurse documents the
initial care plan and any
modifications to it in the hospice
record pursuant to receiving the
physician's verbal order(s). Once
the nurse has a verbal request,
he/she should convey this to HP for
dispensing. The verbal orders on the
hospice plan of care must be signed
by the physician to complete the
hospice record.
Who is responsible to contact the
prescribing physician?
HP needs a signed prescription for
any CII opioid analgesic controlled
substance. Once the nurse
provides HP with the physician’s
name, phone number, and verbal
request to dispense, we will
contact him/her to verify the
prescription. Only then will HP
fax a prescription to the physician
and dispense the medication.
What happens when there are no
more renewals available on a
partially filled medication request?
When a maintenance prescription
(an HP prescription that the
patient has been taking without
any change in dosage) of a CII
opioid analgesic has run out, HP
will ask the nurse to verify that 1)
the physician of record is still
caring for the patient and, 2) the
phone number is accurate. HP
will then contact the physician to
obtain approval to reauthorize the
prescription and to dispense the
requested medication.
What if the physician cannot be
reached or refuses to authorize the
continuation of therapy?
If the physician is not available or
is unwilling to authorize the
continuation of the medication
therapy, HP is unable to dispense
the requested medication. The
nurse will be contacted to coordinate
alternative physician
authorization (e.g., through the
hospice medical director). The
nurse may want to call the
physician first to provide an
updated patient assessment and
learn whether continuation of
therapy will be authorized.
What if a physician refuses to sign a
request that he/she verbally
authorized?
When a physician refuses to sign
prescriptions or has multiple
unsigned prescriptions on our
records, the HP pharmacist will
inform the nurse that we are no
longer able to dispense the
requested medication until a
signed prescription is received.
Often, a covering medical director
will agree to do this.
What’s the Bottom Line?
The bottom line is that HP works
closely with the nursing staff to
assure that dispensing records are
in compliance with the regulations
that allow us to serve
hospice patients. The nurse must
know the physician and keep
him/her informed of the current
plan of care and of the
prescription transfer process. HP
must keep accurate records and
dispense the appropriate medication
to meet the needs of the
hospice patient. At times, an
alternative physician to authorize
or sign a prescription for the
patient may be required.
Please share this process with your
nurse colleagues, and share your
questions and comments with
Stephanie Zarus, PharmD, Chief
Performance Officer at 215-282-
1609.
Nurse Education Corner
–Laura Lutz, External Education Coordinator
Hospice Pharmacia is pleased to
announce that 166 nurses received
CNE credit for participating on the
February 2003 educational webconference
“Palliative Care in
Amyotrophic Lateral Sclerosis”. We
wish to thank those who posed
challenging questions and completed
evaluation forms. Over 95%
of the participants rated the overall
program with a 4 or 5 out of 5.
Many interesting comments and
suggestions for upcoming CE topics
were offered. Additionally, we would
like to congratulate Jill Astolfi,
PharmD for her clinical insight and
for making this program a success.
As a reminder, a post-test as well as
an evaluation form must be
submitted with 70% or more of the
questions answered correctly in
order to receive CNE credit. Please
visit our website at
www.hospicepharmacia.com to
explore “Palliative Care in
Amyotrophic Lateral Sclerosis” and
other available CNE modules. You
Web-Teleconference Calls
APRIL
MAY
JUNE
HP Orientation Call- 4/3/03 @ noon
XRxO Training Call for Hospices- 4/15/03 @ 1pm
XRxO Training Call for Physicians- 4/16/03 @ 7pm
Xeris Training- 4/17/03 @ 1:00pm
HP Orientation Call- 5/1/03 @noon
Dementia CE Program- 5/6/03 @ noon
Dementia CE Program- 5/8/03 @ 3:00pm
MUGs Version 5- 5/14/03 @ 9am
Xeris Training- 5/15/03 @1:00pm
MUGs Version 5- 5/15/03 @ noon
MUGs Version 5- 5/16/03 @ 1pm
MUGs Version 5- 5/19/03 @ 9am
MUGs Version 5- 5/20/03 @ noon
XRxO Training Call for Hospices- 5/20/03 @ 1pm
MUGs Version 5- 5/21/03 @ noon
XRxO Training Call for Physicians- 5/21 @7pm
Orientation Call- 6/5/03 @noon
XRxO Training Call for Hospices- 6/17/03 @1pm
XRxO Training Call for Physicians- 6/18/03 @7pm
Xeris Training- 6/19/03 @ 1:00PM
APRIL
MAY
JUNE
can now download these previously
offered modules, complete the posttest
and submit for credit.
HP’s Continuing Nurse Education
programs focus on the palliation of
symptoms and management of
specific disease states for hospice
patients. If you have any recommendations
for future topics or need
help accessing previous modules,
please contact Laura Lutz, External
Education Coordinator at 215-282-
1664 or e-mail llutz@excellerx.com.
Thank you for your interest and
commitment to HP’s educational
development! Please join us for our
next CNE conference call.
Registration invitations will be sent to
all hospices the week of April 7, 2003.
Please see the list of upcoming conference
calls for more details or visit
our website
www.hospicepharmacia.com.
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www.excellerx.com
www.excellerx.com

Passionate for the Appropriate Use of Medication
Passionate for the Appropriate Use of Medication
d
ecisions
rescribed either
lpidem during a
iod. In the
(n=4065), 4.1%
ts discontinued
ation for reasons
e drug reactions,
l issues. In the
(n=687), 6.7%
s discontinued
ication for the
each group, the
reason for
was “lack of
the medication
for the patient
am and 67% for
enty-five of the
discontinued
e switched to
irteen of these
discontinued
ack of efficacy.
ve results bring
ost-appropriate
Dr. Knowlton.
ications produce
with similar
ellerx.com
discontinuation patterns, while
one costs more than ten times the
other per day, it make sense to use
the less expensive one.”
Likewise, when three long-acting
opioids – morphine, oxycodone,
and transdermal fentanyl – were
com-pared among 13,168 patients,
the percent of discontinuation was
very similar (1-2%). There was
also no difference in the three
agents when comparing clinical
endpoints of average pain score
and constipation.
“Despite the evidence, we spend
millions of unnecessary dollars on
opioids like transdermal fentanyl
and long-acting oxycodone, when
the ‘Gold Standard’ first line
agent, morphine, is shown to have
the same efficacy and
discontinuation rate as the other
agents in this study,” said Dr.
Knowlton.
“The information presented shows
how evidence-based tools can and
will improve the quality of care
provided not just at the end of life,
but in healthcare in general.
When prescribing decisions are
aided with post-marketing
surveillance data, physicians are
able to both focus on the best
interests of the patient and keep
the healthcare system costs in
check,” he added.
Orsula Voltis Thomas, PharmD, MBA
VP & Chief Marketing Officer
phone: 215-282-1602
e-mail: Orsula@excelleRx.com
Clinical Status Markers
continued from page 8
You can enter this data for your
patients at any time through Xeris
and the telephone-based Automatic
Refill/Discharge System (ARDS) and
Related Measures of Endpoints and
Outcomes (RoMEO). Your Pharmaceutical
Care Support Center
pharmacists will ask these questions
with each encounter if you have not
already entered it into Xeris. Status
markers should be tracked for all
patients, as patients with COPD can
experience pain and patients with
CHF also can experience constipation.
This sequential progress
data will enable you, your team, and
the HP pharmacists to better create
effective, goal-based treatment plans
for your patients.
Medication U
Guidelines
continued from page
• Quetiapine fuma
for psychiatric s
present in patien
Parkinsons dise
• Isosorbide mono
as an alternate c
cardiac disease
• Insulin 70/30 (N
Humulin® 70/3
insulin preparat
Deletions in M
include:
• Docusate/Casan
(PeriColace®), a
available
Quote of the Mon
I would like to commend the staff at
Pharmacia for the smooth transiti
services. The process of changing prot
our skilled nursing facilities to the p
rate went extremely smoothly. The st
very helpful and the training an
cooperation was outstanding. Everyo
responsive to our needs and I was
pleased with the lack of disruption
patients and partners in these faci
-Carol Rodrigues RN MS CHPN
Director, Hospice of Western New England
www.exc

Passionate for the Appropriate Use of Medication volume 3 | issue 2 7
HP Launches
“Relationship
Partners”
We are very pleased to announce
that our Relationship Partners
initiative is in full swing!
Our newly created team of
“Relationship Partners” is an 2003
emerging group of PharmD
liaisons strategically located across
the U.S. This team is charged with
the responsibility of visiting with
each Hospice Pharmacia Partner in
their regions monthly to quarterly.
Each Relationship Partner is a
palliative care trained pharmacist
who will serve as an educational
resource and touchstone for any
quality-related issues.
Our current RP’s are:
Karla Anderson, PharmD (5/03)
South West (CA, AZ, UT, NV)
Breann Bruton, PharmD
South Central (TX, AR, OK, NM)
Allie Crandell Owens, PharmD
(4/03)
Central South East (TN, VA, SC,
NC)
Deanna Douglass, PharmD
Mid West Central (MO, KS, IL,
KY)
Rebecca Lewis, RPh, PharmD
National VP and Midwest North
(MI, MN, WI, IN)
Vik Patel, PharmD (5/03)
North East I (CT, NY)
Jim Williamson, RPh, PharmD(c)
North East II (PA, NJ, MD, DC)
April - June 2003 Meetings
Hospice Pharmacia Conferences:
4th Joint Clinical Conference
(NHPCO & NHPNA)
April 10-12, 2003
Adam's Mark Hotel - Denver, CO
Washington State Hospice
Organization (Annual Conference)
April 28-30, 2003
Quinault Beach Resort & Casino -
Ocean Shores, WA
Sponsoring Dessert Reception
Indiana State Hospice
Organization (Annual Conference)
May 2, 2003
Adam's Mark Hotel - Indianapolis, IN
Sponsoring Karen Taylor Good
Pennsylvania Hospice Network
(Annual Conference)
May 4-6, 2003
7 Springs Resort - Champion, PA
25th Annual Northern New
England Home Care Conference &
Trade Show (Tri-State)
May 7-8, 2003
Holiday Inn by the Bay - Portland, ME
Gold Level Sponsor
3rd Annual Hospice Inpatient Unit
Conference
May 8-9, 2003
Riviera Hotel - Las Vegas, NV
Super Sponsor of this event
23rd New York Hospice & Palliative
Care State Conference (Annual
Conference)
May 8-9, 2003
Crown Plaza Hotel - Albany, NY
Sponsor Karen Taylor Good
Illinois State Hospice Organization
(Annual Conference)
May 16, 2003
Hilton Hotel - Lisle, IL
Sponsor Karen Taylor Good
Michigan Hospice & Palliative Care
Organization
May 18-20, 2003
Crystal Mountain Resort -
Thompsonville, MI
Sponsor Karen Taylor Good
Massachusetts State Meeting
(Annual Conference)
May 22, 2003
Tower Hill Botanic Garden - Boylston,
MA
Hospice Pharmacia & Bells, Mills, &
Murphy will sponsor event
Hospice Pharmacia CNE Maine
Workshop
May 29, 2003
Sheraton Hotel (Airport) - South
Portland, ME
Kentucky Association of Hospice &
Palliative Care (Annual Conference)
June 5-6, 2003
Holiday Inn Hurstbourne - Louisville,
KY
Co-Lunch Sponsor
Hospice & Palliative Care Council
of Vermont (Annual Conference)
June 12-13, 2003
Lake Morey Inn - Lake Fairlee, VT
www.excellerx.com

8 volume 3 | issue 2
Passionate for the Appropriate Use of Medication
Clinical Notes
Clinical Notes
Clinical Status Markers
Status markers are data points that
represent a patient's physical,
psychological, and/or clinical status
in time. We categorize clinical status
markets into two groups: Endpoints
(clinical benchmarks such as pain
levels) and Outcomes (quality of life
indicators, such as interaction with
others).
Hospice Pharmacia is targeting 10
significant domains where status
markers will track your patient’s
progress over time. They are: pain,
constipation, nausea, anxiety,
dyspnea, lethargy, interaction with
others, insomnia, appetite, and
quality of life. The "grading" for
each marker is based on a basic
Numeric Rating Scale (NRS). The
range is from 0 to 10, where 0
represents "no" symptom or
impairment issues and 10 represents
the "worst possible" symptom or
impairment that the patient has ever
experienced. “N/A” is used when the
data is unavailable (i.e., the
symptom cannot be assessed due to
the patient’s current condition or
where a clinical assessment has not
been completed).
The current clinical status markers
are:
1) In the last 72 hours, how would
the patient rate his/her worst pain?
2) In the last 72 hours, how would
the patient rate his/her
constipation?
3) In the last 72 hours, how would
the patient rate his/her nausea?
4) In the last 72 hours, how would
the patient rate his/her anxiety?
5) In the last 72 hours, how would
the patient rate his/her shortness
of breath?
6) In the last 72 hours, how would
the patient rate his/her fatigue?
7) In the last 72 hours, how would
the patient rate his/her appetite?
8) In the last 72 hours, how would
the patient rate his/her ability to
sleep?
9) In the last 72 hours, how would
the patient rate his/her ability to
interact with family and friends?
10) In the last 72 hours, how would
the patient rate his/her quality of
life?
The documentation will be
performed in Xeris with a tool
similar to this:
Endpoints
No pain
No constipation
No nausea
No anxiety
No shortness of breath
Not tired
From the Patient’s Perspective
1 2 3 4 5 6 7 8 9 10 n/a
1 2 3 4 5 6 7 8 9 10 n/a
1 2 3 4 5 6 7 8 9 10 n/a
1 2 3 4 5 6 7 8 9 10 n/a
1 2 3 4 5 6 7 8 9 10 n/a
1 2 3 4 5 6 7 8 9 10 n/a
Worst possible pain
Worst possible constipation
Worst possible nausea
Worst possible anxiety
Worst possible shortness of
breath
As tired as possible
Outcomes
Satisfied with Interaction
with Others
No Problem Sleeping
Best Possible Appetite
Quality of Life is Best
Possible
1 2 3 4 5 6 7 8 9 10 n/a
1 2 3 4 5 6 7 8 9 10 n/a
1 2 3 4 5 6 7 8 9 10 n/a
1 2 3 4 5 6 7 8 9 10 n/a
www.excellerx.com
Unsatisfied with Interaction
with Others
Cannot Sleep at All
Worst Possible Appetite
Quality of Life is Worst Possible
continued on next page