Archive for January, 2012

Bar Codes Improves Anesthesia Safety

13 Jan

Ludwik Fedorko, MD, PhD, staff anesthesiologist at the University Health Network’s (UHN) Toronto General Hospital in Canada, recently referred to the operating room as a “black hole of medication safety.” He did so last month at a session on OR drug safety at the 2011 American Society of Health-System Pharmacists.

Dr. Fedorko made a point of highlighting the fact that anesthesiologists are the only health care professionals in a hospital setting who can dispense, premix, repackage, relabel and administer medications without independent verification. Also, according to Fedorko the postanesthesia care unit has accounted for 81 percent of all medication error reports in hospitals.

That said, anesthesia errors are quite rare, with a rate between 0.1 to 0.85 percent, or one of every 1,000 drug-dose administrations. Most of these errors can be reversed.

“We can almost always dig ourselves out of a hole,” Dr. Fedorko said. “The event is charted, but it doesn’t always show up as an error.”

That’s not to say hospitals wouldn’t welcome improvements, especially given the uniqueness of the OR.

“Throughout the hospital, there are safety steps in place to prevent medication errors, but not in the OR.”

So an initiative was started, led by Esther Fung, RPh, director of pharmacy operations at UHN, with a pharmacy–anesthesia collaboration exploring a point-of-care, computer-aided syringe labeling, bar-coding and verification process. The system, which came about with the help of funding from the Canadian Patient Safety Institute and sponsors in the drug industry, was implemented in January 2010.

During the process, the anesthesiologist scans every drug ampoule and syringe label to verify accuracy throughout drug dispensing, premixing, administration and documentation. In five months, the bar-coding system had been used for over 60,000 doses in more than 4,000 surgeries.

Anonymous surveys were performed with the participating anesthesiologists, and 21 of the 41 surveyed reported 29 medication errors which were all intercepted by bar-code scanning. About 97 percent said they preferred using the bar-code scanning system.

Some of the benefits beyond catching medication errors were time-savings and low costs for implementing.

“They understood that it would not only prevent them from making drug errors, but also that it improved and automated workflow in terms of easier charting and documentation because they would no longer have to do it manually,” said Dr. Fedorko.


CMS Proposes 2012 Changes to Payment Policy and Rates

02 Jan

The Centers for Medicare & Medicaid Services (CMS) has made public their proposed rules that will affect doctors, hospital outpatient departments (HOPD), ambulatory surgical centers (ASC), and suppliers of renal dialysis services in 2012.

Highlights from the proposed rule changes include updates to payment policies and rates for 2012 and measures being taken to continue to implement the provisions of the Affordable Care Act meant to improve the quality of care, but also reduce government spending.

Under the law as it is today, Medicare payment rates for physician services face a 29.5 percent reduction in 2012 based on the Sustainable Growth Rate (SGR) formula. Along with other advocates, CMS is against this reduction, which means it is unlikely that physicians will receive such a drastic pay cut.

“Today, the Centers for Medicare & Medicaid Services (CMS) issued proposed rules that spell out how this cut is calculated and warned that if Congress does not act in time, doctor fees will be slashed come January 1. We cannot – and will not – let this happen,” wrote CMS Administrator Donald Berwick, MD on

The Medicare Physician Fee Schedule rule proposed for next year would also update a number of physician incentive programs, including the Physician Quality Reporting System, the e-Prescribing Incentive Program, and the Electronic Health Records Incentive Program.

You can view the proposed changes to these physician incentive programs over at the
Centers for Medicare & Medicaid Services website. Some of the highlights include:

– Expansion of its multiple procedure payment reduction to the professional interpretation of advance imaging services to recognize the overlapping activities that go into valuing these services

– Revision of the criteria for a health risk assessment (HRA) to be used in conjunction with annual wellness visits (AWVs)

– Expanding of the list of services that can be furnished through Telehealth to include smoking cessation servicesRevisions to the quality and cost measures that would be used in establishing a new value-based modifier that would reward physicians for providing higher quality and more efficient care.

1 Comment

Posted in Medicare