The Pulmonary Press

MedGroup
Volume 2, Issue 1, September 2010

Prescription Errors

Electronic prescriptions significantly reduce medication errors according to a study in the Journal of General Internal Medicine. Researchers compared the number and severity of prescription errors between 15 health care providers who adopted e-prescribing and 15 who continued to write prescriptions by hand. A review of the paper-based prescriptions and electronic prescriptions found that one year after adopting e-prescribing, the percentage of errors dropped from 42.5% to 6.6% for the providers using the electronic system. For those who continued to write prescriptions by hand, the percentage of errors increased slightly from 37.3% to 38.4%. Illegibility problems were completely eliminated by e-prescribing.

Do you use a Metered  Dose Inhaler (‘puffer’)?

The FDA recently identified seven more inhaler medications (Tilade Inhaler, Alupent, Azmacort, Intal Inhaler, Aerobid Inhaler, Combivent, and Maxair) that will be phased out over the next three years. Other metered dose inhaler drugs have already been phased out and this new round begins shortly. These inhalers contain ozone-depleting chlorofluorocarbons (CFCs), which are propellants that move medication out of the inhaler and into the lungs of patients. Alternative medications that do not contain CFCs are available.

Important differences in the ‘feel’ associated with the new propellant gas (hydrofluoroalkane) may make you to think you aren’t getting the same full puff-dose as you did when the medication was pushed out by the CFC, but you are.

When does the Treatment Need To Be Ended?

Nebulizers produce a mist of the drug that is placed in the medication cup and then inhaled. The drug remaining in a Nebulizer after therapy ranges from 0.1 to 2 mL.  Some patients tap the nebulizer cup and continue aerosol therapy past the point of sputtering in order to get the last few drops to mist. Some nebulizers will sputter for extended periods of time after the majority of the inhaled dose has been administered. Evidence suggests that after the onset of sputter, very little additional drug is inhaled. Because the time it takes to administer the drug is a critical factor for patient adherence to therapy, some clinicians have adopted recommendations to stop nebulizer therapy at, or one minute after, the onset of sputter. Newer nebulizers may use microprocessors to monitor how much dose has been administered and automatically turn off the nebulizer at the end of each dose.
(AARC “Guide to Aerosol Delivery Devices for Respiratory Therapists”)

Medicare Corner

The Deficit Reduction Act of 2005 arbitrarily capped reimbursement for Medicare home oxygen at 36 months. The resulting regulations for home oxygen therapy from the Centers for Medicare and Medicaid Services (CMS) have caused confusion, service disruption, and reduced access to care for many of the more than one million seniors in Medicare with COPD and other lung diseases who require home oxygen therapy. Moreover, the net effect of the Deficit Reduction Act and the Medicare Improvements for Patients and Providers Act of 2008 has been a 27 percent cut in reimbursements for home oxygen therapy in 2009. In Medicare, home oxygen therapy costs less than $7 per day.

Currently home oxygen policies end reimbursements for oxygen services and equipment after 36 months. The new oxygen rules do not account for the required range of services and the realities of providing oxygen therapy to patients. These policies also do not recognize costs associated with unscheduled emergency visits.

Under the CMS rule, the original home oxygen provider must continue to provide, without any payment, for a two-year period following the reimbursement cap: unscheduled service and maintenance visits; 24 hour, 7 day a week emergency care; equipment repairs; and oxygen supplies and accessories.

Home oxygen providers offer far more than just equipment. They are also front-line caregivers. They educate patients on the proper use of their equipment, answer patients’ questions, make repairs and adjustments, and ensure that patients are receiving the prescribed amount of oxygen. These providers are one of the primary points of contact for many Medicare patients.