HP Newsletter - Hospice Pharmacia

Passionate for the Appropriate Use of Medication
Volume 5 | Issue 3
An Omnicare Company
“Proven and Safer...”
Application of Evidence-based Algorithms Increases Quality Measures and
Reduces Medication Costs in Hospice Patients
- Calvin H Knowlton, RPh, MDiv, PhD, CEO
In This Issue
excelleRx Institute Update
2
Medication Use Guidelines
3
excelleRx Supports Care
Coordination Solutions
Forum for WHCoA
4
Hospice Fund Raisers
4
Dear Laura
5
HP Update
6
Clinical Pharmacology via
Xeris
7
Research Update
7
IT Corner
8
The steady stream of reports about medication
misadventuring and the burgeoning public health
crisis related to patient safety consistently lead us at
Hospice Pharmacia to strengthen our resolve toward
evidence-based pharmaceutical care, and to act on our
insights in “real-time.”
For instance, in a recent JAMA article, Drs. Lucian
Leape and Donald Berwick, well-known vanguards
of patient safety and quality improvement, reported
on progress in the five years following the Institute of
Medicine (IOM) report on patient safety titled, “To
Err is Human.” 1,2 Leape and Berwick noted that,
although formidable barriers to progress in systemwide
patient safety exist, the health care industry is
well positioned to increase the velocity of systemwide
improvements. One of the four key strategies
they cited is “wide diffusion of proven and safe
practices.” Towards that end, Hospice Pharmacia
(HP) is immersed in the evolution of three key service
components that will generate an even more robust
evidence base for the proven and safe practices that
Leape and Berwick champion. These innovations
include HP’s:
1) Peer-reviewed, evidence-based Medication Use
Guidelines (MUGs);
2) Collaborative Practice model for pharmaceutical
care management; and
3) Risk stratification engine, “advisoRx,” that
allows the immediate identification of patients
at greatest risk for medication related problems
(MRPs), enabling an expedient resolution
through nurse/prescriber communication
followed by aggressive monitoring.
Most hospice clinicians are familiar with HP’s
Medication Use Guidelines, a tool that has grown in
scope and sophistication over the past nine years.
Many of your hospice colleagues have been involved
in the review of the MUGs and are keenly aware of
the excelleRx pharmacist/authors’ year long labor of
primary literature review. What you may not know is
that our research team conducts a variety of studies,
drawing on our ever-growing patient database to
validate these guidelines.
In a recently completed study to evaluate the
effectiveness of HP’s Collaborative Practice model and
select symptom management protocols, we examined
differences in symptom scores between two groups
of randomly selected patients: a) those who received
selected first line MUG therapies for pain, insomnia,
or nausea and b) those who received medications
prescribed outside of Collaborative Practice and the
MUGs to treat the same symptoms (N=50/group for
each symptom protocol comparison). Outcomes were
patients’ self-reported measures of symptom intensity
using a 0-10 numeric analog scale. Highlights from
this study include:
• Pain: 28% of patients receiving either sustainedrelease
morphine or oxycodone achieved a
complete response, as compared with 24% of
patients prescribed fentanyl.
- This finding suggests that transdermal opioids
are no more effective in treating pain than
less expensive sustained-release oral agents,
which supports HP’s position that transdermal
fentanyl should be reserved for those patients
who require transdermal administration of
an opioid medication due to dysphagia, GI
absorption problems, etc.
continued on page 8
www.hospicepharmacia.com

2
Passionate for the Appropriate Use of Medication
Education Corner
- Jillian N. Prusakowski, PharmD, Education Manager
The excelleRx Institute is committed to
collaborating with hospices to enhance
pharmacotherapy outcomes for patients
through education, research and participation
in public policy. As a benefit to hospices, we
provide palliative care educational programs to
enhance practice and career growth for health
care professionals.
“Introduction to Non-opioid and Opioid Pain
Therapy” was offered as a web teleconference
in February. There were 173 hospices
registered for this program. Over 440 health
care professionals received credit for this
continuing education session. This program is
now available online as an independent study.
“Beyond Opioids: Adjuvant Drug Therapy”
was conduced in May. There were 116
hospices registered and over 312 health care
professionals received continuing education
credit for the program!
Most recently in August, we presented
“Pharmacotherapy for the Anxious and
Agitated Patient.” Approximately 200
hospices registered and roughly 900 health
care professionals requested to participate!
Other CNE modules available online are listed
below. Please visit the recently updated CNE
website www.hospicepharmacia.com. The
programs available include:
Palliative Sedation in Hospice Patients
Palliative Care in Amyotrophic Lateral
Sclerosis
Palliative Care in Patients with
Dementia
Palliative Care in Huntington’s
Disease
Palliative Treatment of Dyspnea
Management of Seizures in
End of Life Care
The Palliative Management of
Insomnia
Introduction to Non-opioid and
Opioid Pain Therapy
Beyond Opioids: Adjuvant
Drug Therapy
Pharmacotherapy for the Anxious
and Agitated Patient
“Management of Common Gastrointestinal
Complaints at the End of Life,”
will be held on:
• November 8, 2005 at 9:00am EST
• November 9, 2005 at 12:00pm EST
• November 10, 2005 at 3pm EST
Laura Scarpaci, PharmD is the speaker.
She is the Palliative Care Pharmacy Practice
Resident at the University of Maryland,
School of Pharmacy.
This CE program is designed to equip nurses
with the tools needed to manage common
gastrointestinal symptoms encountered at
the end of life such as nausea, vomiting and
diarrhea.
An overview of recent advances will
be provided in addition to a review
of pharmacological agents and nonpharmacological
techniques typically used
in the management of these troubling
symptoms. The presentation will also
incorporate several cases to demonstrate
how the material can be applied to real-life
situations.
After participation in the program, the
audience will be able to:
1. Identify common etiologies associated
with nausea, vomiting, and diarrhea at
the end of life.
2. Differentiate between the available
pharmacological agents for the
treatment of common end-of-life
gastrointestinal symptoms with regards
to their mechanism of action, side
effects, and indications.
3. Create an appropriate drug regimen
based on patient-specific factors and
clinical appropriateness for managing
common end-of-life gastrointestinal
symptoms.
If you would like to learn more about the
excelleRx Institute educational programs,
please contact Dr. Jill Pfeiffenberger,
Director of Education for the excelleRx
Institute, by calling 877.882.7822, ext
1677 or by emailing jillp@excellerx.com.
Register now for
education regarding
HP’s Seventh Edition
of the Medication Use
Guidelines!
www.hospicepharmacia.com

Passionate for the Appropriate Use of Medication 3
HP’s Seventh Edition of the Medication Use Guidelines
- Douglas J. Weschules, PharmD, BCPS, VP of Clinical Services
HP announces the release of the seventh
edition of the Medication Use Guidelines
(MUGs)! excelleRx has been hard at work
for the past twelve months creating this new
volume, and we cannot wait to place it in
your hands. The workload assumed by the
MUGs committee was the most aggressive in
excelleRx’s history, with over 500 hours spent
in the authorship of guidelines, protocols
and monographs alone. Over 40 different
topics were included in the development
of this seventh edition of the MUGs, 28 of
which were suitable for external review. HP
sincerely thanks each of the 34 development
clinicians and 11 internal review editors and
staff for rising to this challenge.
The changes associated with the seventh
edition of the MUGs are not limited to just
the review topics themselves, however. The
process associated with MUGs development
also continues to mature every year.
Noteworthy examples of this evolution
this year include the development and use
of guideline templates for Development
Clinicians (authors) to follow, as well as the
grading of evidence associated with these
documents.
So, what will you see in this new edition?
Completely new guidelines include:
• Urinary Incontinence
• Bowel Obstruction
• Failure to Thrive/Debility, Unspecified
New medications and therapy options for
existing guidelines include:
• Roxicodone tablets, 15 and 30 mg
• Valproic acid-based SeizureKit
Additional detail and enhancements have
also been added to the following guidelines:
• Alzheimer’s Disease
• Anxiety
• Agitation
• Congestive Heart Failure
• COPD
• Nociceptive Pain
• Urinary Tract Infections
Many medications were reviewed but not
added to the seventh edition of the MUGs,
either because of a lack of evidence to
support their use in the hospice population
or because MUG alternatives exist that are
comparable and/or more cost effective.
Medications included in the external review
process that were not added to the MUGs are
outlined below by reason:
Not enough evidence to support their
addition to the MUGs:
• Antihypertensives for the palliation of
end stage CVA
• Donepezil (Aricept®)
• Galantamine (Razadyne®)
• Hydromorphone sustained-release
(Palladone®)
• Memantine (Namenda®)
• Nebulized dexamethasone for COPD or
dyspnea
• Nebulized lidocaine for cough
• Pregabalin (Lyrica®)
• Tiagabine (Gabitril®)
• Tiotropium (Spiriva®)
• Valproic acid for the management of
agitation associated with dementia
A comparable MUG medication already exists
and/or is more cost-appropriate:
• Albuterol sulfate/ipratropium bromide
(DuoNeb®)
• Citalopram (Celexa®)
• Clopidogrel (Plavix®)
• Dalteparin (Fragmin®)
• Enoxaparin (Lovenox®)
• Levetiracetam (Keppra®)
• Morphine sulfate sustained-release
capsule (Avinza®)
• Olanzapine (Zyprexa®)
• Torsemide (Demadex®)
• Tramadol (Ultram®)
In addition, the following medications were
reviewed internally, but were not part of the
external review process:
• Acetylcysteine (Mucomyst®)
• Carvedilol (Coreg®)
• Magnesuim oxide (Mag Ox®)
• Oral ketamine (Ketalar®)
• Quinine sulfate
As you can see, the external review process
was robust. Many clinicians from partnering
hospices and programs participated in
this process. The vast majority of external
reviewers agreed that each document they
reviewed provided a thorough analysis of
each topic, a complete literature review, and
agreed with the findings of the author. A few
questions and concerns were highlighted
throughout this process, all of which helped
to influence the MUGs committee’s ultimate
decisions for the seventh edition of the
MUGs. If you are interested in participating
in the external review process in the future,
please let us know!
The Seventh Edition of the MUGs will be
mailed to Hospice Pharmacia partners in
the next several weeks and will be effective
on November 1st, 2005. Information
regarding the preparatory teleconferences
is available on our website.
If you have any questions regarding the
release of the MUGs, or about any of
its content, please contact the MUGs
committee at MUGs@excellerx.com.
www.hospicepharmacia.com

4
Passionate for the Appropriate Use of Medication
excelleRx Supports Care Coordination Solutions Forum for WHCoA
- Diane Jones, MSW, Director of excelleRx Institute
excelleRx joined several national fundraising
organizations in supporting a critical White
House Conference on Aging (WHCoA)
Solutions Forum, Care Coordination
Across the Continuum. The event focused
on articulating cutting edge solutions
rather than repeating the many well-known
problems associated with our current
healthcare system. Held at the Russell Senate
Office Building on July 19, 2005, an expert
panel of 15 luminaries spoke to an audience
comprised of policy makers, non-government
organizations, healthcare industry leaders
and the press.
The Care Coordination Across the Continuum
Solutions Forum was among hundreds of
grass roots events that have been held across
the country over the past year and a half for the
purpose of making recommendations to the
WHCoA Policy Committee for consideration.
The recommendations presented by the
Care Coordination event specifically deal
with healthcare in the final years of life and
envision a healthcare system with seamless
coordination of comprehensive, reliable, and
readily accessible medical care and supportive
services over time and across settings.
Adherence to evidence-based standards and
guidelines for treatments, medication therapy
management, and services, was one of several
critical elements of optimal coordinated care
advanced by the Solutions Forum.
The full report from the Care Coordination
Across the Continuum Solutions Forum can
be downloaded at www.medicaring.org/
whcoa. For information about other activities
of the White House Conference on Aging go
to www.whcoa.gov. If implemented, these
recommendations could have sweeping
impact on the delivery of health care for the
next decade.
JoAnne Reifsnyder, PhD, SVP of Research
and Innovation at excelleRx and Diane Jones,
MSW, Director of the excelleRx Institute
were members of the planning committee.
Jones also coordinated the event.
The White House Conference on Aging
occurs once a decade to make aging policy
recommendations to the President and
Congress, and to assist the public and
private sectors in promoting dignity, health,
independence and economic security of
current and future generations of older
persons. The upcoming White House
Conference on Aging will be the first one
of the 21st century and is scheduled to
take place December 11 – 14, 2005 in
Washington, DC.
Here are two specific steps you can take to
get your voice heard:
• Call the offices of your Congressperson
and Senator, and be sure that their
health staffers are on board. You can
use the online Congressional Directory
to find contact information.
• Use the WHCoA online contact
form and tell them how important it
is that they pay attention to serious
chronic illness, continuity, and
caregiving - and that they follow at
least the recommendations of the Care
Coordination Across the Continuum
Solutions Forum.
HOSPICE FUND-RAISERS...
Attention non-for-profi t hospices and for for-profi t hospice
foundations that are looking for a turn-key fund-raising event: “A
Good Idea” fund-raiser event, featuring singer-song writer Karen-
Taylor Good, may work for you!
If you are unfamiliar with Ms. Good’s talents and abilities either, visit
www.hospicepharmacia.com and click on “Hospice Fund-Raiser” or,
attend our annual Hospice Appreciation Dinner on Friday September
23rd, where Karen will highlight components of her fundraising ideas.
If you would like to share a good idea for a hospice fund-raiser, send
your idea to HPPartners@excelleRx.com!
www.hospicepharmacia.com

Passionate for the Appropriate Use of Medication 5
Dear Laura,
I use HP’s Xeris on-line tools often and recently noticed two new
icons on the toolbar. Can you explain what these are for?
Lori
Lori,
I’m glad to hear that you are enjoying the benefits of Xeris
enough to realize its multitude of functions! The first new icon
(the second one up from the bottom on the toolbar) links you
to Gold Standard Multimedia’s Clinical Pharmacology clinical
information database. This on-line database provides extensive
drug information, such as general drug descriptions, product
identification, and patient education. Please refer to the related
article in this newsletter.
The second new icon, which is the very last one on the toolbar, is
our Xeris Help link. This link will provide a demonstration on how
to perform different functions in Xeris. Currently, a demonstration
of the admissions process is posted. We will be adding
demonstrations on profiling medications, discharging patients,
refilling medications, Xeris Hospice Administrator functions, and
more! Stay Tuned!
Thanks!
Dear Laura,
I was trying to refill a medication through your Automated
Refill and Discharge System (ARDS) and it prompted me
to enter my PIN after I keyed in my patient’s social security
number. I don’t have a PIN and can’t remember my
password for Xeris. What should I do?
Gwen
Gwen,
The Xeris Hospice Administrator (XHA) at your hospice
has enabled your Xeris account for PIN since the system
is prompting you for one. That was the correct thing to
do since you are a nurse and will be using the Medication
Management Support Center (MMSC) and its services.
Please see your XHA so that he or she can reset your
password. You can then use this new temporary password
to login to Xeris and create a PIN. You will need your PIN
any time you call HP or use the telephone automation for
one of your patients on service. Please let your XHA know
if you have any questions on the process.
Thanks!
Laura
Laura
Laura Lutz is the Client Development Manager at Hospice Pharmacia. She is responsible for coordinating implementations
and for supporting new hospice partners as they transition from their current pharmacy providers to HP. Laura also helps
with the planning and organization of HP’s educational programs, including monthly Xeris training and orientation webteleconferences.
Laura can be reached by emailing HPPartners@excelleRx.com.
Hospice Pharmacia is a service of excelleRx, Inc., an Omnicare Company.
© Copyright 2005 Xeris, Predictive Pharmacotherapy Outcomes System (PPOS), Prospective Medication Management, Medication Use Guidelines (MUGs), ComfortPak, SeizureKit,
Hospice Pharmacia Collaborative Practice (HPCP), 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.
www.hospicepharmacia.com

6
Passionate for the Appropriate Use of Medication
HP Continues to Enhance Quality While Adding Opportunities for Savings
Streamlined Performance Incentive Program, Added Discount on AWP for Medications Outside
of Protocol, and the Lowest Annual Price Adjustment Ever
- Calvin H. Knowlton, RPh, MDiv., PhD, CEO
Hospice Pharmacia is very pleased to
announce an enhanced and simplified
Performance Incentive Program (PIP),
effective October 1, 2005, simultaneous
with the launch of the new edition (VII) of
the Medication Use Guidelines. There are
two components to this new PIP, which will
be assessed each month and automatically
applied to your monthly statement.
1. Earn a 0.50% discount for having 85%
of your home care patients assessed for
ComfortPaks.
2. Earn a 0.75% discount for having
a functional interface between your
software and HP’s Xeris software. A
functional interface means either an FTP
or HL7 interface whereby >75% of your
referrals/admissions are communicated
successfully via the electronic interface.
We have removed the PIN, outcomes
reporting, and automated refills performance
benchmarks as we have found the reporting
functionality, especially reporting by nurse,
is already a great incentive for hospices to
encourage their staff to use their PIN. The
automated refill system will become much
easier with the introduction of voice to text
technology (targeted for 4q05) where the
nurse may say the patient’s phone number,
the PIN, and the refill number, instead of
having to use the telephone key pad.
Additionally, with the recent merger, wherein
excelleRx became a division of Omnicare, we are
able to take advantage of enhanced purchasing
power on medications that were traditionally
low volume for our organization—basically
the non-MUG medications. Therefore, also
effective October 1, 2005, we will be reducing
the medication price on our non-MUG
medications. Certainly, this is not to encourage
the use of non-MUGs!
HP’s per diems are set based upon a hospice’s
percentage of patients with cancer (vs. noncancer)
diagnoses. We have very specific and
detailed information correlating increased
HP encounters and medication mix with
higher cancer rates. While we monitor this
information on a quarterly basis, this year has
been significant in that dozens of our hospices
have received a per diem reduction letter from
HP because their cancer rate has dropped to
a lower bracket for two consecutive quarters
(e.g., from 45% to 35%).
Finally, every October is when most of our
hospice clients receive an annual per diem
price adjustment. This October will be the
lowest price adjustment in HP’s nine year
history—less than half of the 4.4% Producer
Price Index for Opioids (which is what
we use as our upper threshold each year).
Specifically, the HP per diem will increase
less than 2%, effective October 1, 2005.
Because AWP (Average Wholesale Price) is
adjusted by pharmaceutical manufacturers,
hospices are left without any controls on drug
pricing in the fee-for-service environment.
HP’s documented ability to help hospices
control costs is exemplary considering the
continued double-digit pharmacy increases
experienced in the healthcare industry
today.
So, in addition to our system for Prospective
Medication Therapy Management, our new
economies of scale are helping to hold down
your total pharmacy costs!
“I appreciate all that hospice pharmacia does for us.
I have been involved in hospice care for six years and
I think that Hospice Pharmacia does a wonderful
job helping the nursing staff to understand what can
sometimes make us feel so lost. Many thanks.”
Partnering Hospice Nurse
August, 2005
www.hospicepharmacia.com

Passionate for the Appropriate Use of Medication 7
Research Update
- Terri Maxwell, RN, PhD(c)
Clinical Pharmacology
via Xeris
As you may have read in our last newsletter,
HP has entered into a partnership with Gold
Standard Multi-Media. The outcome of this
partnership is that Clinical Pharmacology is
now available through a special subscription
to Xeris users! Hospice Pharmacia partners
can enjoy a 90-day free trial, that began
August 1, 2005.
With several studies underway, and several in the pipeline, there is a lot happening in the
Research Department. Current study topics include:
• Examining patient response to long-acting opioids measured on a 0-10 pain rating scale;
• Testing and evaluating our “Patient Reported Outcomes Measures” (PROM) system
that uses innovative IVR technology;
• Evaluating the effects of prospective medication therapy management on patient
hospitalizations and after-hours nursing visits in hospice;
• Evaluating factors that predispose hospice patients to experiencing a fall; and
• Describing groups of hospice patients: pediatric patients, patients with heart failure,
and patients with dementia.
We look forward to sharing the findings from these studies in upcoming newsletters.
After the trial period, hospice partners may
continue their access through a discount
program that translates to a savings of up to
75% for any hospice with greater than four
users!
Clinical Pharmacology provides the most
up to date and accurate drug information
available, and features:
• Medication Monographs
• Therapeutic Class Overviews
• Search Capabilities (for medications by
brand/generic, indication, therapeutic
classification, contraindication, adverse
reaction)
• Drug Interaction Reports
• Adverse Reaction Reports
• Product Identification
• Patient Education
Founded in 1993, Gold Standard is a leading
developer of drug information databases,
software, and clinical information solutions.
HP is pleased to be able to provide you with
even more resources to facilitate the best
possible patient care.
For more information on this special offering,
email HPPartners@excelleRx.com.
Calling All Hospice Medical Directors and
Clinical Research Staff:
JOIN US FOR A RESEARCH TELECONFERENCE!
Title: Building the Evidence Base for Hospice Symptom
Management: A Research Teleconference for
Hospice Medical Directors and Clinicians
Date: Monday, October 24, 2005
Time: 12 pm-1 pm EDT
Objectives:
• Identify gaps in the evidence base for common
symptoms experienced at the end of life.
• Discuss challenges associated with documentation of
outcomes in hospice.
• Describe findings from recent investigations related
to symptom control, epidemiology, and medication
selection in hospice.
Facilitator: Richard Stefanacci DO, MGH, MBA, AGSF,
CMD, Executive Director, University of the Sciences in
Philadelphia Health Policy Institute
www.hospicepharmacia.com

8
Passionate for the Appropriate Use of Medication
“Proven and Safer...”
continued from page 1
“I forgot my PIN!”
- Mark Schreiber, Technical Support
Manager
We are delighted that more than 80%
of our hospice clients are participating
in the PIN (Personal Identification
Number) program. The purpose of the
PIN program is to comply with HIPAA’s
Privacy Rule.
Just a reminder: Even if a hospice team
member does not use Xeris, he or she
still needs a Xeris account in order to
obtain a PIN number, as we establish
and keep record of nurse profiles in
Xeris. Every HP hospice has selected
a Xeris Hospice Administrator (XHA)
who serves as the Xeris security liaison
between the hospice and HP. The XHA
is authorized to create Xeris accounts
and reset Xeris passwords. Since PIN
is managed through Xeris, your XHA is
authorized to reset your PIN, should you
forget it what it is.
You may also consult the Xeris Reference
Manual with questions. An updated
version of this manual may be found
on the Xeris Welcome Page in the “HP
Announcements” section.
Your Regional Director of Client
Development (RDCD) is available to
assist with any of the above steps. If you
have any further questions regarding
PIN, please contact your RDCD, or email
HPPartners@excelleRx.com. If you are
an XHA and require technical assistance,
feel free to contact our Technical Support
team at support@excellerx.com.
• Insomnia: A statistically significant
number of patients receiving temazepam
(a first line therapy for insomnia in the
MUGs) achieved a complete response as
compared with zolpidem (52% vs. 22%,
p < 0.05).
- This finding suggests that HP’s first
line therapy of temazepam is more
effective in treating insomnia than
zolpidem, a common medication
that is used outside of the insomnia
protocol.
• Nausea: A statistically significant
proportion of patients receiving
prochlorperazine (HP’s first line therapy
for nausea) achieved a complete response
as compared to patients taking oral
ondansetron, an expensive alternative
commonly prescribed in the oncology
community (48.9% vs. 26.7%; p < 0.05).
The study also found a striking difference
between patient groups that experienced
worsened nausea control after initiating
therapy (8.9% for prochlorperazine vs.
26.7% for ondansetron, p < 0.05).
- This finding suggests that
ondansetron is not superior to
prochlorperazine, in treating
nausea that is secondary to an
unknown etiology (e.g. not receiving
chemotherapy or radiation).
We launched the aforementioned study
to test the hypothesis that HP’s evidencebased
Medication Use Guidelines are
associated with better hospice and patientrelated
outcomes. Our findings suggest
that evidence-based prescribing using the
MUGs produces better patient outcomes
when compared to “preference-based”
prescribing.
In addition, while this study was not
constructed to analyze the cost-effectiveness
of the symptom management medications
selected for analysis, it is noteworthy that
HP’s first-line therapies in this study are
less costly than the non-MUG medications
to which they were compared.
These findings support the application of
the MUGs as evidence-based guidelines
that both improve symptom management
and assure cost-appropriate medication
selection for hospice patients, especially
when applied under the prescriberdirected,
pharmacist-driven Collaborative
Practice model.
The bottom line: When the right medication
is selected the first time and the patient is
monitored for therapeutic and potential or
actual adverse effects, patients are not just
more comfortable, they experience greater
safety from untoward adverse medication
outcomes. “Proven and safer”—goals that
should concern every one of us—are within
reach and available to our health care
system’s frailest patients including those
who are receiving hospice care as they
approach the end of life.
1
Leape, L.L. , and Berwick, D.M. (2005). Five years
after To Err is Human: What have we learned? JAMA,
293 (19), 2384-2390.
2
Kohn, K.T., Corrigan, J.M., & Donaldson, M.
(1999). To err is human: Building a safer health care
system. Washington, DC: National Academy Press.
excelleRx Newsletter Staff
Editor In Chief:
Orsula Voltis, PharmD, MBA
Chief Marketing Officer
orsula@excelleRx.com
Managing Editor:
Dana Filippoli
Senior Director of Marketing
dfilippoli@excelleRx.com
Layout and Design:
Melissa Morris
Graphic Designer
www.hospicepharmacia.com