Transcript Solid_Oral_Dosage_Indentification_Gordon_Schiff

Pill Identification
Where do We Stand/Sit/Rest?
Open Medicines Meeting FDA 6/20/2106
Gordon Schiff MD
Associate Director Center for Patient Safety Research and
Practice
Brigham and Women's Hospital Div. General Medicine
Safety Director – Harvard Center for Primary Care
Academic Improvement Collaborative
Associate Professor of Medicine Harvard Medical School
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Background
• Longstanding issues indentifying pills
– Handkerchiefs, pill organizers, other countries/languages
– Primary care, poison control centers, police, patients themselves
• >500,000 calls/year to Poison Control Centers for pill ID
• Akin to everyone choosing own license plate number
• USP Standardized Imprint Code Resolutions (+ WHO)
– 1990 and 2000 urging development of universal coding system.
– Also interest by WHO for international standards
• USP Task force
– Key players
– Made good progress in moving toward consensus
– Ultimately stalled by industry concerns
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2006 Study
• SODID (Solid Oral Doses ID )
– Funded ASPH; USP
• Survey experience and attitudes of clinicians
in identifying medications utilizing current
resources
• Objectively measure ability and time to
actually identify unknown medications
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AJHP
2006
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Methods
Survey
• Participants: MDs & RPhs
– MDs: random sample of 50
practicing PCPs at BWH and
Cook County-Rush
– RPhs: random sample of 50:
• ½ Hospital based
• ½ Outpatient community based
• Topics: how often, resources
used, perceived success rates
and barriers, views on
standard imprint code
• Administered face-to-face
• > 90% response rate
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Tablet ID Exercise
• 3 commonly used “unknown”
tablets
• Naturalistic setting
– Actual workplace/offices
– Allowed/encouraged to
use all available resources
• RA observes, records:
– Time taken, behaviors
observed
• Scoring: Correct, Partial
(name no dose), Wrong,
Unable to Identify
Perceived Ease and Accuracy of IDing Tablets
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Success at identifying after
consulting resources?
How easy is it to identify
tablets?
45%
40%
20
35%
30%
15
N
25%
10
20%
15%
5
so
al
5%
ys
y
ea
0%
sy
< 25%
ul
sy
ic
ea
ff
ti
m
es
le
ti
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pr
ic
di
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a
ll
wa
ua
s
di
ys
me
us
ti
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wa
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me
of
al
0
10%
MDS
Pharmacists
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25-49%
50-74%
75-99%
100%
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OTC Tablet
Photo courtesy Bill Salkin, CPhT
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10
Reality vs. Perception (RPh)
90%
80%
70%
60%
3 Correct (75-100%)
50%
2 Correct (50-74%)
40%
1 Correct (25-49%)
30%
None Correct (<25%)
20%
10%
0%
Exercise
Survey
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Average time to identify tablet
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22
43
99
6
Physicians
67
27
18
15
86
88
7
57
Pharmacist
0
<1min
1-2 min
2-5 min
5-10 min 10-20 min 20-30 min
1
2
3
4
5
6
>30 min
7
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So Where do we Stand in 2016
• Web resources minimizing need?
• Too difficult to overcome resistance?
– Various issues related to retooling, transitions,
counterfeit drugs, regulatory relabeling, others
• Who is owning/working on problem?
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Questions for OpenMedicine
• Important?
• Unmet Need?
• In Scope?
• Priority?
• Steps to take?
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