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‘No More NUPOR’ Mooing and Musing #2


The original ‘No More NUPOR’ post is here. To remind you – NUPOR is Near Universal Pharmacist Order Review, the current state of practice for medication orders. There is a group of informatics professionals that are questioning this scared cow. Here is the latest in what will be a series of commentaries on the subject.

The following is a series of email conversations with some very high placed influential pharmacy leaders. Their names are not revealed as the points are more important than who said them.

First this was noticed in the March 2009 Journal of Health System Pharmacy.

Executive Summary on the Global Conference for Hospital Pharmacy Practice (August 2008): “Optimally, all medicine orders should be reviewed by a pharmacist, but many countries do not have adequate resources to support this practice. Hospital pharmacists should assess which patients or patient care areas are in the greatest need of this service and then focus their order-review efforts on those patients or patient-care areas.”

This position more or less endorses the concept of NUPOR that is clearly not universally accepted, yet a standard of practice in the US.

The next suggestion was that this statement 

“is essentially the "endorsed" preamble to (no more) NUPOR….”

Which was then noted that

“This is essentially the internationally "endorsed" preamble to (no more) NUPOR….”

It occurred to me that some may take pot shots that the US is far better than most countries, to which I shot back (with out thinking beyond that)

“I can hear is now “what do those for-ners know’, we are better than that. That’s when you pull out this graph (below). [not from Michael Moore but a software biz plan]”

This is an amazing graph from a presentation at the 2008 Connected Health Seminar at Harvard by Brian Bosworth founder of Keas, Inc.



Wouldn’t you know it? This was received within seconds:

“I attended and participated in the global conference in Basel and I also sit on the Joint Commission International (JCI) standards committee. I would caution any of you about looking at the statements from the conference or the JCI standards as something to which we should aspire in this country. For these groups the bar is set pretty low in order to establish a minimum baseline toward which to strive. For example, many countries don’t even have pharmacists in hospitals at this point in time – so I couldn’t even get the JCI committee to agree that a pharmacist should designated as being responsible for pharmacy services in hospitals.”

Clearly the person had not seen my post, so I thought I was going to be in big trouble.  I responded back:

Opps. I better qualify my previous email. My only point in the slide I sent (which strikes me as incredible) is that if Life Expectancy is a macro indicator of how well a health system does, then we suck and are paying way too much. A socialist view is that it is all insurance company greed and overhead, which, I admit is partly my view. Culture (mostly obesity) comes into it, so does delivery of pharmaceuticals. So, from a micro pharmacy view, looking at other countries health delivery systems need to be looked at and not dismissed out of hand.

Phew, dodged a bullet on that with the response

I agree 100% with you John that most of the money spent on healthcare in this country is a waste – and going to insurance executives, pharmaceutical companies, administrative overhead, bureaucratic BS and consultants. And individuals need to start taking responsibility for their own health – like all the third world countries. Then we would have much more money to give to GM!

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