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October 22, 2014   Download print version

Utility workers indicted over brain-eating amoeba testing

Price displays for physicians – Which price is right?

New report demonstrates hospitals value Group Purchasing Organizations

Medication errors occur every 8 minutes in U.S. children

As Ebola patients vanish in Liberia’s health system, survivors go on a desperate search

PDI Prevantics Device Swab 3.15% Chlorhexidine Gluconate/70% alcohol solution receives FDA market authorization

CVS plays hardball with rival drug chains

Reminder: HPN to salute Supply Chain Operations Worth Watching


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Utility workers indicted over brain-eating amoeba testing

Two Louisiana utility workers have been indicted for allegedly failing to test the water supply for a brain-eating amoeba and then lying about it.

In late August, St. John the Baptist Parish officials told 13,000 people in three Louisiana towns that the deadly amoeba, called Naegleria fowleri, had been found in their water supply. The following month, state police officers began to inspect inconsistencies in the water inspection data, according to ABC New Orleans affiliate WGNO.

Utility workers Kevin Branch, 54, and Danielle Roussel, 43, were both indicted Monday on one count of failing to perform a duty required of a public employee and another count of creating and maintaining false public records, according to the indictment obtained by ABC News.

Naegleria fowleri causes primary amoebic meningoencephalitis, an extremely rare but almost invariably fatal brain infection, according to the U.S. Centers for Disease Control and Prevention. The amoeba thrives in warm freshwater and enters the brain through the nose. This infection is not caused by drinking water contaminated by the amoeba.

A 4-year-old boy from a nearby parish died last year after contracting the amoeba while playing on a Slip 'N Slide. Afterward, New Orleans flushed its water supply with chlorine. In July, 9-year-old Hally Yust died after being infected with the amoeba in Kansas.

According to the grand jury indictment filed Monday, investigators compared the water inspection logs with data from the GPS devices on Branch's and Roussel's parish vehicles and concluded that Branch did not stop at 30 of the 48 water inspections he claimed to have done between Aug. 1 and Aug. 27. And Roussel did not stop for three of the six inspections she claimed to have completed over the same period, the indictment states.

There have been 132 other reported cases of Naegleria fowleri infections between 1962 and 2013, with only a handful occurring each year, according to the CDC. By comparison, about ten people die in unintentional drownings per day, the agency said. Four of those Naegleria fowleri cases occurred in Louisiana. Visit ABC News for the article.



Price displays for physicians – Which price is right?

Does your physician know the cost of the test he just ordered for you, and what are the ethical implications, either way? In response to research indicating that healthcare costs go down when physicians are shown the cost of tests at the time of ordering, a pair of medical ethicists at Johns Hopkins has outlined the ethical issues that need consideration when designing and displaying prices for physicians.

The Viewpoint article in The Journal of the American Medical Association (JAMA) highlights a core problem with price displays: In modern medicine "price" can refer to various types of charges, including cost of service provision, cost plus profit, charges, or expected reimbursement, among others. Some of these prices may vary by as much as 10-fold – from $11 up to $142 for a complete blood count, for example. Displaying the right price is important, as well as where the price came from and what it means, may also be important to display.

"Price displays are growing in popularity, and yet these different possible meanings of price have different ethical implications," says Matthew DeCamp, co-author of the study. For example, DeCamp says, displaying the highest possible price might more effectively lower costs, but could it cause physicians not to order beneficial interventions? How do price displays relate to patients’ concerns about out-of-pocket expenses?

"These and other ethical issues must be considered before the price displays become widely implemented," says DeCamp. Both he and co-author Kevin Riggs are practicing physicians in the Johns Hopkins Division of General Internal Medicine and are affiliated with the university’s Berman Institute of Bioethics.

The authors recommend these ethical considerations be taken into account when deciding which price to display:

Transparency — "At the very least, reference to the source of the price should be shown alongside the price display."

Informing Patients — "Protecting patient autonomy requires informing patients that price displays are being used."

Protecting Well-Being — there must be protection against the "risk of patients not receiving beneficial services."

Ensuring Fair Treatment — "Fairness mandates that price displays should not systematically disadvantage certain patient groups," for example, uninsured patients. "Displaying the same amount for all patients could help ensure they are treated fairly."

"This is new territory, clinically and ethically, and we need more research into how displays operate in practice," says Riggs. "Displaying prices to physicians could help put resources to their best use, but to fully realize that potential these ethical considerations must be kept in mind."

Visit JAMA for the study.



New report demonstrates hospitals value Group Purchasing Organizations

The vast majority of hospitals utilize Group Purchasing Organizations (GPOs) to bend the healthcare cost curve and meet patient supply needs. This is just one finding from a new survey conducted by Wharton School and sponsored by the American Hospital Association (AHA) and the Association for Healthcare Resource & Materials Management (AHRMM). The survey also finds that while hospital's purchasing decisions are driven by clinical rather than financial considerations, GPOs succeed in obtaining price discounts and lower product prices for hospitals.

"This important report shows GPOs provide a valuable service for the hospital field," said Rick Pollack, AHA Executive Vice President. "By helping them manage supply costs, hospitals utilize GPOs as a very important tool in their supply chain toolbox."

Highlights from the survey, conducted for AHA and AHRMM by The Wharton School at the University of Pennsylvania, include:

·         Ninety percent of hospitals utilize national GPOs, with an average tenure of 11 years as members.

·         Hospitals route the majority of their product purchases (56%) through their primary GPO.

·         Eighty-eight percent of hospitals agree or strongly agree that their GPO generates savings from lower prices.

"Our study shows that not only do GPOs provide cost savings, but they help hospitals meet their need for physician preference items," said Lawton Robert Burns, Ph.D., MBA, professor, The Wharton School and lead author. "In addition, GPOs help hospitals purchase everything from commodity items to pharmaceuticals to dietary items."

Visit AHRMM for a copy of the survey report.



Medication errors occur every 8 minutes in U.S. children

A child receives the wrong medication or the wrong dosage every eight minutes in the United States, according to a recent study released online on Oct. 20 in the journal Pediatrics.

Nearly 700,000 children under 6 years old experienced an out-of-hospital medication error between 2002 and 2012. Out of those episodes, one out of four children was under a year old. As the age of children decreased, the likelihood of an error increased, the study found.

Though 94 percent of the mistakes didn't require medical treatment, the errors led to 25 deaths and about 1,900 critical care admissions, according to the study.

"Even the most conscientious parents make errors," said lead author Dr. Huiyun Xiang, director of the Center for Pediatric Trauma Research at Nationwide Children's Hospital in Columbus, OH. That conscientiousness may even lead to one of the most common errors: Just over a quarter of these mistakes involved a child receiving the prescribed dosage twice.

"One caregiver may give a child a dose, and then a second caregiver, who does not know that and wants to make sure the child gets the proper amount of medicine, may give the child a dose, too," Xiang said. Other reasons for errors included incorrectly measuring the dosage or overprescription of some medications, he said.

Xiang and his colleagues analyzed all the medication errors reported to the National Poison Data System for all children under 6 years old during the study period.

Another common feature was that eight of every 10 errors involved liquid medication.

"Young children are more likely to be given liquid medicine than medicine in other forms, like tablets or capsules," he said, especially since many prescription and over-the-counter children's medications are in liquid form.

"A second reason is that liquids can be difficult to measure correctly," Xiang said. "Some liquid medications are measured in milliliters, other in teaspoons, some with measuring cups, some with syringes. That can be confusing to parents and caregivers."

A different study -- from the August issue of Pediatrics -- found that using teaspoons or tablespoons to administer children's medications was behind many drug dosing errors. Instructions requiring teaspoons or tablespoons made it twice as likely that parents or another caregiver would incorrectly follow the doctor's prescription than if the instructions were in milliliters, that study found. An error was even more likely if parents used a kitchen spoon to measure out the dose, according to the earlier study.

In the current study, Xiang's team also found that errors involving cough and cold medicines suddenly dropped by two-thirds from 2005 to 2012, a dive likely linked to two events, Xiang said. In 2007, the U.S. Food and Drug Administration announced that it was reviewing the safety of over-the-counter cough and cold medicines for children and soon after, manufacturers voluntarily withdrew those drugs from shelves for children under 2 years old.

Shortly thereafter, the American Academy of Pediatrics said that cough and cold medicines weren't effective in children under 6, and that those medications might pose a health risk to young children.

While errors related to those medicines dropped, however, mistakes involving other medications increased by 37 percent, though the study did not look at why.

"It may be associated with the increased use of analgesics and antihistamines among young children," said Xiang.

Pain relievers and cough and cold medicines each comprised about a quarter of all the errors identified, and antihistamines made up 15 percent of the errors. Antibiotics made up about 12 percent. The medications causing the highest rate of hospitalization or death included muscle relaxants, cardiovascular drugs and mental health drugs, such as sedatives and antipsychotics. (HealthDay) Visit NIH for the report



As Ebola patients vanish in Liberia’s health system, survivors go on a desperate search

MONROVIA, Liberia — Ebola ravaged this capital so quickly that some patients passed through an already broken medical system with hardly any paper trail. Others were admitted to one clinic and transferred to another without notice. Hundreds were cremated long before their families were notified that they had died.

The world has heard about the deaths. Ebola has claimed 2,500 lives in this country, most of them in Monrovia. But the epidemic has also left in its trail another form of grief and anguish for those whose friends and relatives are missing. About 30 percent of Ebola victims survive. That’s the number many here obsess over — it is just high enough to offer hope and to fuel uncertainty.

Their vigil is a reflection of a medical system so overwhelmed by the virus that it has lost track of both the living and the dead. The United States and other foreign donors are working with the Liberian government to improve its system of medical records. Some clinics and hospitals have started posting more accurate lists of the deceased on their front walls, where families now gather, collapsing into tears as soon as the names appear. But many are left without even a hint of their loved ones’ whereabouts.

Relatives and friends spend hours each day outside the city’s four Ebola clinics. Some come to pray. Many are not sure if they’re in the right place. They wait for visiting hours, held in special partitioned spaces, even though the loved ones they are looking for never show up. They check patient lists, even though they’re almost always incomplete. They ask nurses for help, even though the requests usually don’t yield information.

Speaking with the families of the missing has become a second job for hospital employees at Island Clinic — a product of their rare access to the isolation ward.

The streets are still crowded in Monrovia. The markets are still full of men hawking bootleg DVDs, and women selling fruit and bags of rice. Almost everywhere, music blasts from car radios. After sunset, joggers run along a street near the beach.

The city’s four Ebola treatment centers are a world away. Each is fenced off and tightly secured. When relatives arrive, they’re asked to wait outside with other families. They watch men and women in full-coverage "moon suits" through the fencing, sometimes shouting questions to them.

When survivors are released, looking disoriented and lethargic, the crowd outside scans for the familiar face of a loved one. When families hear that their relatives have died, the wailing is immediate and seems to come from all directions.

Visit the Washington Post for the story.



PDI Prevantics Device Swab 3.15% Chlorhexidine Gluconate/70% alcohol solution receives FDA market authorization

Clinical investigators recently released results from the first and only randomized, cross-over, prospective, comparative effectiveness clinical study evaluating the benefits of a 3.15% Chlorhexidine Gluconate (CHG) and 70% Isopropyl Alcohol over 70% Isopropyl Alcohol alone in disinfecting needleless connectors. The study was funded by the US Centers for Disease Control and Prevention (CDC) Epicenters Program and executed by Rush University in Chicago, IL.

The findings align with CDC Guidelines which state: "Some studies have shown that disinfection of the devices with chlorhexidine/alcohol solutions appears to be most effective in reducing colonization."

The investigators determined that the CHG and alcohol scrub resulted in less needleless connector contamination than an alcohol scrub at a five second scrub time. Prevantics Device Swab from PDI, leading provider of infection prevention solutions, is the only 3.15% Chlorhexidine Gluconate and 70% Isopropyl Alcohol solution that has received market authorization from the U.S. Food and Drug Administration (FDA) for disinfecting needleless access sites prior to use.

"This study answers a previously unknown clinical question about the most efficacious antiseptic for disinfection of needleless access sites and also ideal prep times," said Hudson Garrett, PhD, Vice-President, Clinical Affairs for PDI. "This study demonstrates the importance of targeted efforts to reduce contamination on needleless access sites and ensure evidence-based practices for disinfection of needleless access sites."

Visit PDI for the study.



CVS plays hardball with rival drug chains

CVS Health Corp. is offering a prescription-drug plan that charges patients more if they buy their medications at pharmacies that sell tobacco products, a plan that could benefit the company’s own network of drugstores.

The plan, offered by CVS’s pharmacy benefits unit Caremark, features copayments that are up to $15 higher on prescriptions filled where tobacco is sold. That could give people covered by such plans an incentive to buy their medications at CVS, which stopped selling tobacco products last month.

Rival drugstore chains like Walgreen Co. and Rite-Aid Corp. have resisted calls to stop selling tobacco themselves, saying it wouldn’t have a significant impact on smoking rates.

CVS spokeswoman Carolyn Castel said the company created the plan after being approached by Caremark clients interested in creating a tobacco-free pharmacy network. People covered by the new plan would be able to buy medications at the lower copays at Target Corp., which doesn’t sell tobacco, as well as tobacco-free local or regional drugstores.

Still, the company is opening itself up to criticism that it is designing coverage plans that give an advantage to its own pharmacies. David Balto, a former policy director at the U.S. Federal Trade Commission who is now an antitrust attorney, said the tobacco-free network could be problematic if it effectively steers patients to CVS.

"There’s no cost savings that comes about from limiting the network," Balto said. "It’s really another effort to limit the ability of their rivals to effectively compete."

CVS’s tobacco-free network is only in the early stages. The first employer to sign on is the city of Philadelphia, where around 5,400 nonunion employees will have to make an additional $15 copayment if they fill their prescriptions at pharmacies that aren’t part of what is called a preferred health network.

"I look at it as a win-win," says James Startare, the city’s deputy human-resources director, who says his department approached Caremark about the idea. "I think it has long-term positive health impacts, because we want to promote a tobacco-free workforce."

About 100 independent pharmacies and between 150 and 200 CVS stores will participate in the Philadelphia network, Startare said.

Some independent pharmacies are crying foul.

"It’s an unfair competitive practice," said John Giampolo, who heads the Independent Pharmacy Alliance, a trade group and buying cooperative that represents 3,000 pharmacies in New York and three other states. "Consider a local pharmacy that hasn’t carried tobacco for years, but the consumer may not know whether the pharmacy participates or not. So a consumer may go to a CVS pharmacy to save the $15. An independent pharmacy may have to scramble to do their own marketing."

The company says it will provide lists of qualifying pharmacies.

CVS has come under fire in the past for practices that steered its pharmacy-benefits clients to its pharmacies. CVS’s $27 billion acquisition of Caremark in 2007 faced scrutiny from the Federal Trade Commission over just such an issue, and a subsequent investigation was launched in 2009 as well. The FTC concluded its review in 2012 without taking any action on whether CVS was being anti-competitive. Visit the Wall Street Journal for the story.



Reminder: HPN to salute Supply Chain Operations Worth Watching

For the 4th consecutive year, Healthcare Purchasing News is recognizing and saluting healthcare Supply Chain Operations Worth Watching. These involve teams of professionals who seem to go beyond the call of duty to make a difference and succeed as tangible examples for others to follow.

What makes a supply chain op worth watching? What they’re doing and why they matter in the areas of cost-cutting, efficiency-driven, clinically motivated and patient-centric concepts, ideas, activities and outcomes. While these categories may seem rather cut-and-dry statistically, we use anecdotal, unscientific and completely subjective methods to choose organizations, motivated by self-reported innovative thinking and work.

Here’s where we need your help. Within your organization, just tell us who’s doing top-notch, innovative work. We’d like your help in suggesting, justifying and validating these organizations. Mini-profiles of these leading organizations will appear in HPN’s December 2014 edition. HPN has profiled 30 to date, so who in your organization should join this august and elite group? You won’t know unless you nominate a facility by answering the following two questions.

1. What/who are the top 3-5 hospital and/or IDN supply chain organizations you’d recommend for consideration? Please list the organization name, location, contact person and contact information.

2. For each of the recommendations above, please highlight in a few bullet points and/or sentences why you believe this organization’s supply chain operation is one to watch and perhaps emulate?

We’re going to collect the recommendations and evaluate them based on their "nominations." Please note that you or your organization will not be identified as nominating the organization, but if a number of your organizations make the list you’ll certainly earn some bragging rights.

E-mail us your nominations by Friday, October 24, to