Editorial: Decimal Points and Units

Some deaths related to the preparation of pharmaceuticals may involve calculation errors as a result of either a misplaced decimal or misinterpreted "units," such as milligrams for micrograms. A factor of ten times the usual dose, or one-tenth the usual dose, may result with a misplaced decimal point as occurred in the three deaths in Oregon a few months back. The death of a premature infant in a hospital was attributed to selecting 330 milligrams of zinc in place of 330 micrograms.

Secondary checks were supposed to have been made, which may have prevented these sad cases, but these also slipped through the system. Could it be that the way we "check" or "confirm" math calculations is part of the problem?

When asked to check a mathematical calculation, most individuals will look at the problem that is worked out, follow it through, and either approve or disapprove it. How much mental effort is required when checking is done this way? Not much, actually.

However, if the individual doing the checking is simply provided with the problem without the solution, they have to independently work all the way through the problem and then compare the final answer with the work of the original pharmacist. This requires much more mental effort, and errors can usually be caught this way.

Why, then, is this second method not used in all facilities? The answer may be that it possibly takes more time and effort. However, if a little more time and effort was expended in the two cases of fatality mentioned above, there may be 4 more individuals alive today.

One last word from the "soapbox"; more effort needs to be expended in the pharmacy school curricula on ensuring that the graduates are competent in calculations. What does it mean to be competent in pharmacy calculations? It certainly doesn't mean that they get only 70% of their calculations correct! This is the real world; they need to get 100% of their calculations correct! Their patient's life depends upon it.


Loyd V. Allen, Jr., PhD, RPh
Editor-in-Chief

Washington, DC - Tom Murry, PharmD, JD, has been selected as Executive Director of the Pharmacy Compounding Accreditation Board (PCAB), assuming his duties on August 20, 2007. The establishment of PCAB signaled the formal recognition of compounding pharmacies that met the profession's standards of quality. PCAB was created to set those standards, provide assistance to all compounding pharmacies seeking accreditation, and to raise the public's awareness of quality pharmacy compounding practices.

"We are very pleased that Tom is joining the PCAB as its Executive Director," says PCAB President John A. Gans, PharmD. "PCAB is committed to the establishment of uniform accreditation standards for the compounding profession. Pharmacists across the country have made major investments in equipment and education and have developed sophisticated compounding practices to meet the growing health system need for medications not commercially viable. PCAB assures the public that in those accredited and sophisticated practices, national standards are being met. The process ensures that accredited pharmacies from coast to coast have put in place sound practices, processes, facilities, equipment and personnel to prepare compounded medications for their patients."

Dr. Murry earned his pharmacy degree at the University of Arkansas, where he also served as Student Body President for the College of Pharmacy. During pharmacy school, Tom performed internships with the United States Pharmacopeia and the United States Public Health Service. Following graduation, Tom served as the National Community Pharmacy Association's first Executive Resident, and subsequently served as NCPA Director of Student Affairs. In May, Tom graduated from the Campbell University School of Law where he served on the Moot Court team and was inducted into the Order of Old Kivett for excellence in trial and appellate advocacy. While in law school, Tom performed clerkships with the North Carolina General Assembly and the North Carolina Board of Pharmacy. Tom, and his wife Tamara, who is also a pharmacist, have two daughters: Ella, 3 � and Gretchen 10 months.

As Executive Director of PCAB, Murry will lead the accreditation programs and initiatives designed to support compounding pharmacies in their efforts to continuously improve quality practices and enhance patient care.

"I am excited about my new role with PCAB," explained Dr. Murray. "With patient and physician demand for customized medications increasing each year, there is a need for an enhanced, profession-wide system of standards by which each compounding pharmacy can test its quality processes. PCAB Accreditation gives patients and prescribers a way to select a pharmacy that meets the highest quality standards."

Founding of Pharmacy Compounding Accreditation Board (PCAB)
PCAB was established by: the American College of Apothecaries, the American Pharmacists Association, the International Academy of Compounding Pharmacists, the National Association of Boards of Pharmacy, the National Community Pharmacists Association, the National Council of State Pharmacy Association Executives, the National Home Infusion Association and the United States Pharmacopeia.

CMS has provided a quick summary of the tamper-resistant prescription pad guidance to state Medicaid administrators.

1. NOT all Medicaid prescriptions must be written; phone, fax, and electronic transmissions are still allowed.
2. If the prescription is written, it must be on a tamper-resistant blank.
3. It does not apply to refills of prescriptions written prior to October 1, 2008.

There is a procedure for emergency fills that is contingent on the prescriber providing the pharmacy a verbal, faxed, electronic, or compliant written prescription within 72 hours.

Further clarification of the three specific conditions to be "phased in" is provided below:

In the first year, the mandate may require the pads be:

1. Copy-proof, OR
2. Counterfeit-proof, OR
3. Nonerasable or nonalterable

By October 1, 2008, pads must meet all three of these conditions to be deemed compliant.

Currently, there are over 1,200 subscribers sharing their expertise on the CNL. Join the CNL by going to either www.ijpc.com or www.CompoundingToday.com and click on the Compounders' Network and follow the instructions.

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This week 35 citations and abstracts on the topic of androgen disorders in women, focusing on androgen deficiency, especially sexual dysfunction, have been added to CompoundingToday.com's literature search database. See the complete list at www.compoundingtoday.com/Articles/SearchResult.cfm?Batch=131

Online Ordering..
The new trend to ordering food carry-out is to order online (e.g., www.outback.com) and simply drive up and your order is delivered to your car, or drive through and pick it up. Actually, the online menu-driven ordering system (from your office or home, etc.) is quite easy and convenient. How does this relate to pharmacy? With pharmacy's dependence on computerized systems, if you don't already have one for your pharmacy, why not consider implementing an online ordering system for refills. True, it can be done easily with e-mails, but it can also be programmed to provide the patient with options for purchasing other products in the store that can be added to the refills. These systems are great for people in a hurry, for mothers with small children, for the elderly that have difficulty walking, or during inclimate weather.