HP Newsletter - Hospice Pharmacia
HP Newsletter - Hospice Pharmacia
HP Newsletter - Hospice Pharmacia
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Passionate for the Appropriate Use of Medication<br />
Volume 5 | Issue 3<br />
An Omnicare Company<br />
“Proven and Safer...”<br />
Application of Evidence-based Algorithms Increases Quality Measures and<br />
Reduces Medication Costs in <strong>Hospice</strong> Patients<br />
- Calvin H Knowlton, RPh, MDiv, PhD, CEO<br />
In This Issue<br />
excelleRx Institute Update<br />
2<br />
Medication Use Guidelines<br />
3<br />
excelleRx Supports Care<br />
Coordination Solutions<br />
Forum for WHCoA<br />
4<br />
<strong>Hospice</strong> Fund Raisers<br />
4<br />
Dear Laura<br />
5<br />
<strong>HP</strong> Update<br />
6<br />
Clinical Pharmacology via<br />
Xeris<br />
7<br />
Research Update<br />
7<br />
IT Corner<br />
8<br />
The steady stream of reports about medication<br />
misadventuring and the burgeoning public health<br />
crisis related to patient safety consistently lead us at<br />
<strong>Hospice</strong> <strong>Pharmacia</strong> to strengthen our resolve toward<br />
evidence-based pharmaceutical care, and to act on our<br />
insights in “real-time.”<br />
For instance, in a recent JAMA article, Drs. Lucian<br />
Leape and Donald Berwick, well-known vanguards<br />
of patient safety and quality improvement, reported<br />
on progress in the five years following the Institute of<br />
Medicine (IOM) report on patient safety titled, “To<br />
Err is Human.” 1,2 Leape and Berwick noted that,<br />
although formidable barriers to progress in systemwide<br />
patient safety exist, the health care industry is<br />
well positioned to increase the velocity of systemwide<br />
improvements. One of the four key strategies<br />
they cited is “wide diffusion of proven and safe<br />
practices.” Towards that end, <strong>Hospice</strong> <strong>Pharmacia</strong><br />
(<strong>HP</strong>) is immersed in the evolution of three key service<br />
components that will generate an even more robust<br />
evidence base for the proven and safe practices that<br />
Leape and Berwick champion. These innovations<br />
include <strong>HP</strong>’s:<br />
1) Peer-reviewed, evidence-based Medication Use<br />
Guidelines (MUGs);<br />
2) Collaborative Practice model for pharmaceutical<br />
care management; and<br />
3) Risk stratification engine, “advisoRx,” that<br />
allows the immediate identification of patients<br />
at greatest risk for medication related problems<br />
(MRPs), enabling an expedient resolution<br />
through nurse/prescriber communication<br />
followed by aggressive monitoring.<br />
Most hospice clinicians are familiar with <strong>HP</strong>’s<br />
Medication Use Guidelines, a tool that has grown in<br />
scope and sophistication over the past nine years.<br />
Many of your hospice colleagues have been involved<br />
in the review of the MUGs and are keenly aware of<br />
the excelleRx pharmacist/authors’ year long labor of<br />
primary literature review. What you may not know is<br />
that our research team conducts a variety of studies,<br />
drawing on our ever-growing patient database to<br />
validate these guidelines.<br />
In a recently completed study to evaluate the<br />
effectiveness of <strong>HP</strong>’s Collaborative Practice model and<br />
select symptom management protocols, we examined<br />
differences in symptom scores between two groups<br />
of randomly selected patients: a) those who received<br />
selected first line MUG therapies for pain, insomnia,<br />
or nausea and b) those who received medications<br />
prescribed outside of Collaborative Practice and the<br />
MUGs to treat the same symptoms (N=50/group for<br />
each symptom protocol comparison). Outcomes were<br />
patients’ self-reported measures of symptom intensity<br />
using a 0-10 numeric analog scale. Highlights from<br />
this study include:<br />
• Pain: 28% of patients receiving either sustainedrelease<br />
morphine or oxycodone achieved a<br />
complete response, as compared with 24% of<br />
patients prescribed fentanyl.<br />
- This finding suggests that transdermal opioids<br />
are no more effective in treating pain than<br />
less expensive sustained-release oral agents,<br />
which supports <strong>HP</strong>’s position that transdermal<br />
fentanyl should be reserved for those patients<br />
who require transdermal administration of<br />
an opioid medication due to dysphagia, GI<br />
absorption problems, etc.<br />
continued on page 8<br />
www.hospicepharmacia.com
2<br />
Passionate for the Appropriate Use of Medication<br />
Education Corner<br />
- Jillian N. Prusakowski, PharmD, Education Manager<br />
The excelleRx Institute is committed to<br />
collaborating with hospices to enhance<br />
pharmacotherapy outcomes for patients<br />
through education, research and participation<br />
in public policy. As a benefit to hospices, we<br />
provide palliative care educational programs to<br />
enhance practice and career growth for health<br />
care professionals.<br />
“Introduction to Non-opioid and Opioid Pain<br />
Therapy” was offered as a web teleconference<br />
in February. There were 173 hospices<br />
registered for this program. Over 440 health<br />
care professionals received credit for this<br />
continuing education session. This program is<br />
now available online as an independent study.<br />
“Beyond Opioids: Adjuvant Drug Therapy”<br />
was conduced in May. There were 116<br />
hospices registered and over 312 health care<br />
professionals received continuing education<br />
credit for the program!<br />
Most recently in August, we presented<br />
“Pharmacotherapy for the Anxious and<br />
Agitated Patient.” Approximately 200<br />
hospices registered and roughly 900 health<br />
care professionals requested to participate!<br />
Other CNE modules available online are listed<br />
below. Please visit the recently updated CNE<br />
website www.hospicepharmacia.com. The<br />
programs available include:<br />
Palliative Sedation in <strong>Hospice</strong> Patients<br />
Palliative Care in Amyotrophic Lateral<br />
Sclerosis<br />
Palliative Care in Patients with<br />
Dementia<br />
Palliative Care in Huntington’s<br />
Disease<br />
Palliative Treatment of Dyspnea<br />
Management of Seizures in<br />
End of Life Care<br />
The Palliative Management of<br />
Insomnia<br />
Introduction to Non-opioid and<br />
Opioid Pain Therapy<br />
Beyond Opioids: Adjuvant<br />
Drug Therapy<br />
Pharmacotherapy for the Anxious<br />
and Agitated Patient<br />
“Management of Common Gastrointestinal<br />
Complaints at the End of Life,”<br />
will be held on:<br />
• November 8, 2005 at 9:00am EST<br />
• November 9, 2005 at 12:00pm EST<br />
• November 10, 2005 at 3pm EST<br />
Laura Scarpaci, PharmD is the speaker.<br />
She is the Palliative Care Pharmacy Practice<br />
Resident at the University of Maryland,<br />
School of Pharmacy.<br />
This CE program is designed to equip nurses<br />
with the tools needed to manage common<br />
gastrointestinal symptoms encountered at<br />
the end of life such as nausea, vomiting and<br />
diarrhea.<br />
An overview of recent advances will<br />
be provided in addition to a review<br />
of pharmacological agents and nonpharmacological<br />
techniques typically used<br />
in the management of these troubling<br />
symptoms. The presentation will also<br />
incorporate several cases to demonstrate<br />
how the material can be applied to real-life<br />
situations.<br />
After participation in the program, the<br />
audience will be able to:<br />
1. Identify common etiologies associated<br />
with nausea, vomiting, and diarrhea at<br />
the end of life.<br />
2. Differentiate between the available<br />
pharmacological agents for the<br />
treatment of common end-of-life<br />
gastrointestinal symptoms with regards<br />
to their mechanism of action, side<br />
effects, and indications.<br />
3. Create an appropriate drug regimen<br />
based on patient-specific factors and<br />
clinical appropriateness for managing<br />
common end-of-life gastrointestinal<br />
symptoms.<br />
If you would like to learn more about the<br />
excelleRx Institute educational programs,<br />
please contact Dr. Jill Pfeiffenberger,<br />
Director of Education for the excelleRx<br />
Institute, by calling 877.882.7822, ext<br />
1677 or by emailing jillp@excellerx.com.<br />
Register now for<br />
education regarding<br />
<strong>HP</strong>’s Seventh Edition<br />
of the Medication Use<br />
Guidelines!<br />
www.hospicepharmacia.com
Passionate for the Appropriate Use of Medication 3<br />
<strong>HP</strong>’s Seventh Edition of the Medication Use Guidelines<br />
- Douglas J. Weschules, PharmD, BCPS, VP of Clinical Services<br />
<strong>HP</strong> announces the release of the seventh<br />
edition of the Medication Use Guidelines<br />
(MUGs)! excelleRx has been hard at work<br />
for the past twelve months creating this new<br />
volume, and we cannot wait to place it in<br />
your hands. The workload assumed by the<br />
MUGs committee was the most aggressive in<br />
excelleRx’s history, with over 500 hours spent<br />
in the authorship of guidelines, protocols<br />
and monographs alone. Over 40 different<br />
topics were included in the development<br />
of this seventh edition of the MUGs, 28 of<br />
which were suitable for external review. <strong>HP</strong><br />
sincerely thanks each of the 34 development<br />
clinicians and 11 internal review editors and<br />
staff for rising to this challenge.<br />
The changes associated with the seventh<br />
edition of the MUGs are not limited to just<br />
the review topics themselves, however. The<br />
process associated with MUGs development<br />
also continues to mature every year.<br />
Noteworthy examples of this evolution<br />
this year include the development and use<br />
of guideline templates for Development<br />
Clinicians (authors) to follow, as well as the<br />
grading of evidence associated with these<br />
documents.<br />
So, what will you see in this new edition?<br />
Completely new guidelines include:<br />
• Urinary Incontinence<br />
• Bowel Obstruction<br />
• Failure to Thrive/Debility, Unspecified<br />
New medications and therapy options for<br />
existing guidelines include:<br />
• Roxicodone tablets, 15 and 30 mg<br />
• Valproic acid-based SeizureKit<br />
Additional detail and enhancements have<br />
also been added to the following guidelines:<br />
• Alzheimer’s Disease<br />
• Anxiety<br />
• Agitation<br />
• Congestive Heart Failure<br />
• COPD<br />
• Nociceptive Pain<br />
• Urinary Tract Infections<br />
Many medications were reviewed but not<br />
added to the seventh edition of the MUGs,<br />
either because of a lack of evidence to<br />
support their use in the hospice population<br />
or because MUG alternatives exist that are<br />
comparable and/or more cost effective.<br />
Medications included in the external review<br />
process that were not added to the MUGs are<br />
outlined below by reason:<br />
Not enough evidence to support their<br />
addition to the MUGs:<br />
• Antihypertensives for the palliation of<br />
end stage CVA<br />
• Donepezil (Aricept®)<br />
• Galantamine (Razadyne®)<br />
• Hydromorphone sustained-release<br />
(Palladone®)<br />
• Memantine (Namenda®)<br />
• Nebulized dexamethasone for COPD or<br />
dyspnea<br />
• Nebulized lidocaine for cough<br />
• Pregabalin (Lyrica®)<br />
• Tiagabine (Gabitril®)<br />
• Tiotropium (Spiriva®)<br />
• Valproic acid for the management of<br />
agitation associated with dementia<br />
A comparable MUG medication already exists<br />
and/or is more cost-appropriate:<br />
• Albuterol sulfate/ipratropium bromide<br />
(DuoNeb®)<br />
• Citalopram (Celexa®)<br />
• Clopidogrel (Plavix®)<br />
• Dalteparin (Fragmin®)<br />
• Enoxaparin (Lovenox®)<br />
• Levetiracetam (Keppra®)<br />
• Morphine sulfate sustained-release<br />
capsule (Avinza®)<br />
• Olanzapine (Zyprexa®)<br />
• Torsemide (Demadex®)<br />
• Tramadol (Ultram®)<br />
In addition, the following medications were<br />
reviewed internally, but were not part of the<br />
external review process:<br />
• Acetylcysteine (Mucomyst®)<br />
• Carvedilol (Coreg®)<br />
• Magnesuim oxide (Mag Ox®)<br />
• Oral ketamine (Ketalar®)<br />
• Quinine sulfate<br />
As you can see, the external review process<br />
was robust. Many clinicians from partnering<br />
hospices and programs participated in<br />
this process. The vast majority of external<br />
reviewers agreed that each document they<br />
reviewed provided a thorough analysis of<br />
each topic, a complete literature review, and<br />
agreed with the findings of the author. A few<br />
questions and concerns were highlighted<br />
throughout this process, all of which helped<br />
to influence the MUGs committee’s ultimate<br />
decisions for the seventh edition of the<br />
MUGs. If you are interested in participating<br />
in the external review process in the future,<br />
please let us know!<br />
The Seventh Edition of the MUGs will be<br />
mailed to <strong>Hospice</strong> <strong>Pharmacia</strong> partners in<br />
the next several weeks and will be effective<br />
on November 1st, 2005. Information<br />
regarding the preparatory teleconferences<br />
is available on our website.<br />
If you have any questions regarding the<br />
release of the MUGs, or about any of<br />
its content, please contact the MUGs<br />
committee at MUGs@excellerx.com.<br />
www.hospicepharmacia.com
4<br />
Passionate for the Appropriate Use of Medication<br />
excelleRx Supports Care Coordination Solutions Forum for WHCoA<br />
- Diane Jones, MSW, Director of excelleRx Institute<br />
excelleRx joined several national fundraising<br />
organizations in supporting a critical White<br />
House Conference on Aging (WHCoA)<br />
Solutions Forum, Care Coordination<br />
Across the Continuum. The event focused<br />
on articulating cutting edge solutions<br />
rather than repeating the many well-known<br />
problems associated with our current<br />
healthcare system. Held at the Russell Senate<br />
Office Building on July 19, 2005, an expert<br />
panel of 15 luminaries spoke to an audience<br />
comprised of policy makers, non-government<br />
organizations, healthcare industry leaders<br />
and the press.<br />
The Care Coordination Across the Continuum<br />
Solutions Forum was among hundreds of<br />
grass roots events that have been held across<br />
the country over the past year and a half for the<br />
purpose of making recommendations to the<br />
WHCoA Policy Committee for consideration.<br />
The recommendations presented by the<br />
Care Coordination event specifically deal<br />
with healthcare in the final years of life and<br />
envision a healthcare system with seamless<br />
coordination of comprehensive, reliable, and<br />
readily accessible medical care and supportive<br />
services over time and across settings.<br />
Adherence to evidence-based standards and<br />
guidelines for treatments, medication therapy<br />
management, and services, was one of several<br />
critical elements of optimal coordinated care<br />
advanced by the Solutions Forum.<br />
The full report from the Care Coordination<br />
Across the Continuum Solutions Forum can<br />
be downloaded at www.medicaring.org/<br />
whcoa. For information about other activities<br />
of the White House Conference on Aging go<br />
to www.whcoa.gov. If implemented, these<br />
recommendations could have sweeping<br />
impact on the delivery of health care for the<br />
next decade.<br />
JoAnne Reifsnyder, PhD, SVP of Research<br />
and Innovation at excelleRx and Diane Jones,<br />
MSW, Director of the excelleRx Institute<br />
were members of the planning committee.<br />
Jones also coordinated the event.<br />
The White House Conference on Aging<br />
occurs once a decade to make aging policy<br />
recommendations to the President and<br />
Congress, and to assist the public and<br />
private sectors in promoting dignity, health,<br />
independence and economic security of<br />
current and future generations of older<br />
persons. The upcoming White House<br />
Conference on Aging will be the first one<br />
of the 21st century and is scheduled to<br />
take place December 11 – 14, 2005 in<br />
Washington, DC.<br />
Here are two specific steps you can take to<br />
get your voice heard:<br />
• Call the offices of your Congressperson<br />
and Senator, and be sure that their<br />
health staffers are on board. You can<br />
use the online Congressional Directory<br />
to find contact information.<br />
• Use the WHCoA online contact<br />
form and tell them how important it<br />
is that they pay attention to serious<br />
chronic illness, continuity, and<br />
caregiving - and that they follow at<br />
least the recommendations of the Care<br />
Coordination Across the Continuum<br />
Solutions Forum.<br />
HOSPICE FUND-RAISERS...<br />
Attention non-for-profi t hospices and for for-profi t hospice<br />
foundations that are looking for a turn-key fund-raising event: “A<br />
Good Idea” fund-raiser event, featuring singer-song writer Karen-<br />
Taylor Good, may work for you!<br />
If you are unfamiliar with Ms. Good’s talents and abilities either, visit<br />
www.hospicepharmacia.com and click on “<strong>Hospice</strong> Fund-Raiser” or,<br />
attend our annual <strong>Hospice</strong> Appreciation Dinner on Friday September<br />
23rd, where Karen will highlight components of her fundraising ideas.<br />
If you would like to share a good idea for a hospice fund-raiser, send<br />
your idea to <strong>HP</strong>Partners@excelleRx.com!<br />
www.hospicepharmacia.com
Passionate for the Appropriate Use of Medication 5<br />
Dear Laura,<br />
I use <strong>HP</strong>’s Xeris on-line tools often and recently noticed two new<br />
icons on the toolbar. Can you explain what these are for?<br />
Lori<br />
Lori,<br />
I’m glad to hear that you are enjoying the benefits of Xeris<br />
enough to realize its multitude of functions! The first new icon<br />
(the second one up from the bottom on the toolbar) links you<br />
to Gold Standard Multimedia’s Clinical Pharmacology clinical<br />
information database. This on-line database provides extensive<br />
drug information, such as general drug descriptions, product<br />
identification, and patient education. Please refer to the related<br />
article in this newsletter.<br />
The second new icon, which is the very last one on the toolbar, is<br />
our Xeris Help link. This link will provide a demonstration on how<br />
to perform different functions in Xeris. Currently, a demonstration<br />
of the admissions process is posted. We will be adding<br />
demonstrations on profiling medications, discharging patients,<br />
refilling medications, Xeris <strong>Hospice</strong> Administrator functions, and<br />
more! Stay Tuned!<br />
Thanks!<br />
Dear Laura,<br />
I was trying to refill a medication through your Automated<br />
Refill and Discharge System (ARDS) and it prompted me<br />
to enter my PIN after I keyed in my patient’s social security<br />
number. I don’t have a PIN and can’t remember my<br />
password for Xeris. What should I do?<br />
Gwen<br />
Gwen,<br />
The Xeris <strong>Hospice</strong> Administrator (XHA) at your hospice<br />
has enabled your Xeris account for PIN since the system<br />
is prompting you for one. That was the correct thing to<br />
do since you are a nurse and will be using the Medication<br />
Management Support Center (MMSC) and its services.<br />
Please see your XHA so that he or she can reset your<br />
password. You can then use this new temporary password<br />
to login to Xeris and create a PIN. You will need your PIN<br />
any time you call <strong>HP</strong> or use the telephone automation for<br />
one of your patients on service. Please let your XHA know<br />
if you have any questions on the process.<br />
Thanks!<br />
Laura<br />
Laura<br />
Laura Lutz is the Client Development Manager at <strong>Hospice</strong> <strong>Pharmacia</strong>. She is responsible for coordinating implementations<br />
and for supporting new hospice partners as they transition from their current pharmacy providers to <strong>HP</strong>. Laura also helps<br />
with the planning and organization of <strong>HP</strong>’s educational programs, including monthly Xeris training and orientation webteleconferences.<br />
Laura can be reached by emailing <strong>HP</strong>Partners@excelleRx.com.<br />
<strong>Hospice</strong> <strong>Pharmacia</strong> is a service of excelleRx, Inc., an Omnicare Company.<br />
© Copyright 2005 Xeris, Predictive Pharmacotherapy Outcomes System (PPOS), Prospective Medication Management, Medication Use Guidelines (MUGs), ComfortPak, SeizureKit,<br />
<strong>Hospice</strong> <strong>Pharmacia</strong> Collaborative Practice (<strong>HP</strong>CP), and all Xeris products and their respective logos are Trademarks of excelleRx, Inc. All rights reserved. No part of the information<br />
contained herein may be reproduced, duplicated, or copied without permission. Please inquire if you are not sure. PPOS and Xeris are Patent Pending.<br />
www.hospicepharmacia.com
6<br />
Passionate for the Appropriate Use of Medication<br />
<strong>HP</strong> Continues to Enhance Quality While Adding Opportunities for Savings<br />
Streamlined Performance Incentive Program, Added Discount on AWP for Medications Outside<br />
of Protocol, and the Lowest Annual Price Adjustment Ever<br />
- Calvin H. Knowlton, RPh, MDiv., PhD, CEO<br />
<strong>Hospice</strong> <strong>Pharmacia</strong> is very pleased to<br />
announce an enhanced and simplified<br />
Performance Incentive Program (PIP),<br />
effective October 1, 2005, simultaneous<br />
with the launch of the new edition (VII) of<br />
the Medication Use Guidelines. There are<br />
two components to this new PIP, which will<br />
be assessed each month and automatically<br />
applied to your monthly statement.<br />
1. Earn a 0.50% discount for having 85%<br />
of your home care patients assessed for<br />
ComfortPaks.<br />
2. Earn a 0.75% discount for having<br />
a functional interface between your<br />
software and <strong>HP</strong>’s Xeris software. A<br />
functional interface means either an FTP<br />
or HL7 interface whereby >75% of your<br />
referrals/admissions are communicated<br />
successfully via the electronic interface.<br />
We have removed the PIN, outcomes<br />
reporting, and automated refills performance<br />
benchmarks as we have found the reporting<br />
functionality, especially reporting by nurse,<br />
is already a great incentive for hospices to<br />
encourage their staff to use their PIN. The<br />
automated refill system will become much<br />
easier with the introduction of voice to text<br />
technology (targeted for 4q05) where the<br />
nurse may say the patient’s phone number,<br />
the PIN, and the refill number, instead of<br />
having to use the telephone key pad.<br />
Additionally, with the recent merger, wherein<br />
excelleRx became a division of Omnicare, we are<br />
able to take advantage of enhanced purchasing<br />
power on medications that were traditionally<br />
low volume for our organization—basically<br />
the non-MUG medications. Therefore, also<br />
effective October 1, 2005, we will be reducing<br />
the medication price on our non-MUG<br />
medications. Certainly, this is not to encourage<br />
the use of non-MUGs!<br />
<strong>HP</strong>’s per diems are set based upon a hospice’s<br />
percentage of patients with cancer (vs. noncancer)<br />
diagnoses. We have very specific and<br />
detailed information correlating increased<br />
<strong>HP</strong> encounters and medication mix with<br />
higher cancer rates. While we monitor this<br />
information on a quarterly basis, this year has<br />
been significant in that dozens of our hospices<br />
have received a per diem reduction letter from<br />
<strong>HP</strong> because their cancer rate has dropped to<br />
a lower bracket for two consecutive quarters<br />
(e.g., from 45% to 35%).<br />
Finally, every October is when most of our<br />
hospice clients receive an annual per diem<br />
price adjustment. This October will be the<br />
lowest price adjustment in <strong>HP</strong>’s nine year<br />
history—less than half of the 4.4% Producer<br />
Price Index for Opioids (which is what<br />
we use as our upper threshold each year).<br />
Specifically, the <strong>HP</strong> per diem will increase<br />
less than 2%, effective October 1, 2005.<br />
Because AWP (Average Wholesale Price) is<br />
adjusted by pharmaceutical manufacturers,<br />
hospices are left without any controls on drug<br />
pricing in the fee-for-service environment.<br />
<strong>HP</strong>’s documented ability to help hospices<br />
control costs is exemplary considering the<br />
continued double-digit pharmacy increases<br />
experienced in the healthcare industry<br />
today.<br />
So, in addition to our system for Prospective<br />
Medication Therapy Management, our new<br />
economies of scale are helping to hold down<br />
your total pharmacy costs!<br />
“I appreciate all that hospice pharmacia does for us.<br />
I have been involved in hospice care for six years and<br />
I think that <strong>Hospice</strong> <strong>Pharmacia</strong> does a wonderful<br />
job helping the nursing staff to understand what can<br />
sometimes make us feel so lost. Many thanks.”<br />
Partnering <strong>Hospice</strong> Nurse<br />
August, 2005<br />
www.hospicepharmacia.com
Passionate for the Appropriate Use of Medication 7<br />
Research Update<br />
- Terri Maxwell, RN, PhD(c)<br />
Clinical Pharmacology<br />
via Xeris<br />
As you may have read in our last newsletter,<br />
<strong>HP</strong> has entered into a partnership with Gold<br />
Standard Multi-Media. The outcome of this<br />
partnership is that Clinical Pharmacology is<br />
now available through a special subscription<br />
to Xeris users! <strong>Hospice</strong> <strong>Pharmacia</strong> partners<br />
can enjoy a 90-day free trial, that began<br />
August 1, 2005.<br />
With several studies underway, and several in the pipeline, there is a lot happening in the<br />
Research Department. Current study topics include:<br />
• Examining patient response to long-acting opioids measured on a 0-10 pain rating scale;<br />
• Testing and evaluating our “Patient Reported Outcomes Measures” (PROM) system<br />
that uses innovative IVR technology;<br />
• Evaluating the effects of prospective medication therapy management on patient<br />
hospitalizations and after-hours nursing visits in hospice;<br />
• Evaluating factors that predispose hospice patients to experiencing a fall; and<br />
• Describing groups of hospice patients: pediatric patients, patients with heart failure,<br />
and patients with dementia.<br />
We look forward to sharing the findings from these studies in upcoming newsletters.<br />
After the trial period, hospice partners may<br />
continue their access through a discount<br />
program that translates to a savings of up to<br />
75% for any hospice with greater than four<br />
users!<br />
Clinical Pharmacology provides the most<br />
up to date and accurate drug information<br />
available, and features:<br />
• Medication Monographs<br />
• Therapeutic Class Overviews<br />
• Search Capabilities (for medications by<br />
brand/generic, indication, therapeutic<br />
classification, contraindication, adverse<br />
reaction)<br />
• Drug Interaction Reports<br />
• Adverse Reaction Reports<br />
• Product Identification<br />
• Patient Education<br />
Founded in 1993, Gold Standard is a leading<br />
developer of drug information databases,<br />
software, and clinical information solutions.<br />
<strong>HP</strong> is pleased to be able to provide you with<br />
even more resources to facilitate the best<br />
possible patient care.<br />
For more information on this special offering,<br />
email <strong>HP</strong>Partners@excelleRx.com.<br />
Calling All <strong>Hospice</strong> Medical Directors and<br />
Clinical Research Staff:<br />
JOIN US FOR A RESEARCH TELECONFERENCE!<br />
Title: Building the Evidence Base for <strong>Hospice</strong> Symptom<br />
Management: A Research Teleconference for<br />
<strong>Hospice</strong> Medical Directors and Clinicians<br />
Date: Monday, October 24, 2005<br />
Time: 12 pm-1 pm EDT<br />
Objectives:<br />
• Identify gaps in the evidence base for common<br />
symptoms experienced at the end of life.<br />
• Discuss challenges associated with documentation of<br />
outcomes in hospice.<br />
• Describe findings from recent investigations related<br />
to symptom control, epidemiology, and medication<br />
selection in hospice.<br />
Facilitator: Richard Stefanacci DO, MGH, MBA, AGSF,<br />
CMD, Executive Director, University of the Sciences in<br />
Philadelphia Health Policy Institute<br />
www.hospicepharmacia.com
8<br />
Passionate for the Appropriate Use of Medication<br />
“Proven and Safer...”<br />
continued from page 1<br />
“I forgot my PIN!”<br />
- Mark Schreiber, Technical Support<br />
Manager<br />
We are delighted that more than 80%<br />
of our hospice clients are participating<br />
in the PIN (Personal Identification<br />
Number) program. The purpose of the<br />
PIN program is to comply with HIPAA’s<br />
Privacy Rule.<br />
Just a reminder: Even if a hospice team<br />
member does not use Xeris, he or she<br />
still needs a Xeris account in order to<br />
obtain a PIN number, as we establish<br />
and keep record of nurse profiles in<br />
Xeris. Every <strong>HP</strong> hospice has selected<br />
a Xeris <strong>Hospice</strong> Administrator (XHA)<br />
who serves as the Xeris security liaison<br />
between the hospice and <strong>HP</strong>. The XHA<br />
is authorized to create Xeris accounts<br />
and reset Xeris passwords. Since PIN<br />
is managed through Xeris, your XHA is<br />
authorized to reset your PIN, should you<br />
forget it what it is.<br />
You may also consult the Xeris Reference<br />
Manual with questions. An updated<br />
version of this manual may be found<br />
on the Xeris Welcome Page in the “<strong>HP</strong><br />
Announcements” section.<br />
Your Regional Director of Client<br />
Development (RDCD) is available to<br />
assist with any of the above steps. If you<br />
have any further questions regarding<br />
PIN, please contact your RDCD, or email<br />
<strong>HP</strong>Partners@excelleRx.com. If you are<br />
an XHA and require technical assistance,<br />
feel free to contact our Technical Support<br />
team at support@excellerx.com.<br />
• Insomnia: A statistically significant<br />
number of patients receiving temazepam<br />
(a first line therapy for insomnia in the<br />
MUGs) achieved a complete response as<br />
compared with zolpidem (52% vs. 22%,<br />
p < 0.05).<br />
- This finding suggests that <strong>HP</strong>’s first<br />
line therapy of temazepam is more<br />
effective in treating insomnia than<br />
zolpidem, a common medication<br />
that is used outside of the insomnia<br />
protocol.<br />
• Nausea: A statistically significant<br />
proportion of patients receiving<br />
prochlorperazine (<strong>HP</strong>’s first line therapy<br />
for nausea) achieved a complete response<br />
as compared to patients taking oral<br />
ondansetron, an expensive alternative<br />
commonly prescribed in the oncology<br />
community (48.9% vs. 26.7%; p < 0.05).<br />
The study also found a striking difference<br />
between patient groups that experienced<br />
worsened nausea control after initiating<br />
therapy (8.9% for prochlorperazine vs.<br />
26.7% for ondansetron, p < 0.05).<br />
- This finding suggests that<br />
ondansetron is not superior to<br />
prochlorperazine, in treating<br />
nausea that is secondary to an<br />
unknown etiology (e.g. not receiving<br />
chemotherapy or radiation).<br />
We launched the aforementioned study<br />
to test the hypothesis that <strong>HP</strong>’s evidencebased<br />
Medication Use Guidelines are<br />
associated with better hospice and patientrelated<br />
outcomes. Our findings suggest<br />
that evidence-based prescribing using the<br />
MUGs produces better patient outcomes<br />
when compared to “preference-based”<br />
prescribing.<br />
In addition, while this study was not<br />
constructed to analyze the cost-effectiveness<br />
of the symptom management medications<br />
selected for analysis, it is noteworthy that<br />
<strong>HP</strong>’s first-line therapies in this study are<br />
less costly than the non-MUG medications<br />
to which they were compared.<br />
These findings support the application of<br />
the MUGs as evidence-based guidelines<br />
that both improve symptom management<br />
and assure cost-appropriate medication<br />
selection for hospice patients, especially<br />
when applied under the prescriberdirected,<br />
pharmacist-driven Collaborative<br />
Practice model.<br />
The bottom line: When the right medication<br />
is selected the first time and the patient is<br />
monitored for therapeutic and potential or<br />
actual adverse effects, patients are not just<br />
more comfortable, they experience greater<br />
safety from untoward adverse medication<br />
outcomes. “Proven and safer”—goals that<br />
should concern every one of us—are within<br />
reach and available to our health care<br />
system’s frailest patients including those<br />
who are receiving hospice care as they<br />
approach the end of life.<br />
1<br />
Leape, L.L. , and Berwick, D.M. (2005). Five years<br />
after To Err is Human: What have we learned? JAMA,<br />
293 (19), 2384-2390.<br />
2<br />
Kohn, K.T., Corrigan, J.M., & Donaldson, M.<br />
(1999). To err is human: Building a safer health care<br />
system. Washington, DC: National Academy Press.<br />
excelleRx <strong>Newsletter</strong> Staff<br />
Editor In Chief:<br />
Orsula Voltis, PharmD, MBA<br />
Chief Marketing Officer<br />
orsula@excelleRx.com<br />
Managing Editor:<br />
Dana Filippoli<br />
Senior Director of Marketing<br />
dfilippoli@excelleRx.com<br />
Layout and Design:<br />
Melissa Morris<br />
Graphic Designer<br />
www.hospicepharmacia.com