Archive Articles


More Than One Good Reason to Use Skin Prep

Skin, largest organ of the body, is designed to protect against outside forces of evil. The world’s daily caustic barrage of fluids and other traumatic events can take their toll on the healthiest skin. Consider tissues weakened by age and co-morbidities now attempting to withstand these assaults. The care provided must include consideration for maintaining the skin’s integrity. This includes applying barriers that allow for dressing adherence and the natural process of skin sloughing.
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What is Specialty Pharmacy?

If you haven’t already heard the term specialty pharmacy or specialty pharmaceutical, you probably will soon.  With new “specialty drugs” entering the marketplace each year, your patients will eventually have the need for one of these therapies. So what exactly do those two terms mean? Although this seems like a simple question, a standard, industry-wide definition for either term remains elusive.
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Updated Pressure Stages and Terminology Changes Announced by NPUAP

During a convened meeting of over 400 professionals, updated staging definitions and terminology changes were announced. The National Pressure Ulcer Advisory Panel *(NPUAP) is replacing the term “pressure ulcer” with “pressure injury” in the National Pressure Ulcer Advisory Panel Pressure Injury Staging System. The NPUAP believes the changes more accurately describes pressure injuries to both intact and ulcerated skin. Read More

Partially Filled Vials and Syringes in Sharps Containers are a Key Source of Drugs for Diversion

The Institute for Safe Medication Practices recently published practice recommendations related to drug abuse and diversion in healthcare settings. The following has been modified for post-acute and long term care practice settings – full ISMP text is available at   Read More

Diabetes Care: A Paradigm Shift is Underway

In a recent publication of “Diabetes Care” (Diabetes Care 2016;39:308-311) the American Diabetes Association released a position statement for strategies and goals of diabetes management in LTC. Three specific patient populations seen in long term care were identified: 1)Transitional care/rehab; 2) general LTC; and  3) hospice/palliative care. Each of the 3 areas have unique problems, goals, and treatment strategies. A truly patient specific approach is necessary due to the complexities of the patients, complicating comorbidities, and transitions in care. A change in approach to diabetes management is underway in LTC. The tight glycemic control that is the goal of treatment in younger patients and hospitalized patients is not appropriate for the frail elderly due to the risk of hypoglycemia and the complications that occur.
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Body Composition and Wounds

Sarcopenia, from the Greek meaning “poverty of flesh”, is the degenerative loss of skeletal muscle mass and strength associated with aging. Cachexia, on the other hand, is loss of weight and muscle mass caused by disease. It is a complex metabolic syndrome associated with underlying illness.  Read More

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e-Prescribing of Controlled Substances

In 2013, ICP received our first electronic prescription that met stringent DEA requirements for controlled substances.  Making e-prescribing of controlled substances (EPCS) legal nationwide, while a critical step, is only one part of solving the problem of prescription opioid abuse. Read More

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Revised Warnings for Metformin

The US Food and Drug Administration (FDA) has announced that it is revising warnings for the use of metformin in certain patients with reduced kidney function. After reviewing published studies, FDA concluded that metformin can be used safely in patients with mild impairment in kidney function and in some patients with moderate impairment in kidney function. Manufacturers will be required to make changes to the metformin labeling to provide specific recommendations on the drug’s use in patients with mild to moderate kidney impairment.
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Long-Term Care Adviser

The following articles are summarized from a newsletter published by the Institute for Safe Medication Practices (ISMP). The ISMP Long-Term Care Advise-ERR is a medication safety newsletter designed specifically to meet the needs of administrators, nursing directors, and nurses who transcribe medication orders, administer medications, monitor the effects of medications on residents, and/or supervise those who carry out these important tasks. The content also applies to consultant pharmacists, pharmacy providers, respiratory therapists, and medication technicians that work in long-term care settings. The newsletter is currently provided free to those employed by long-term care facilities.
Complete the subscription form at to subscribe. ISMP encourages one person from each long-term care facility to subscribe. This subscriber may redistribute the newsletter to all interested staff who are employed by the long-term care facility or members of the medical staff who practice at the long-term care facility.

2016 National Patient Safety Goals for Long-Term Care

Safety-Wire-Icon-small-(1).jpg  The Joint Commission (TJC) recently released its 2016 National Patient Safety Goals (NPSG) for Long- Term Care (LTC) facilities. While Joint Commission-accredited facilities are expected to comply with the safety measures starting January 1, 2016, we encourage all LTC facilities (even if not accredited by TJC) to adhere to these best practices designed to improve patient/resident safety. Check out the 2016 NPSGs, including easy-to-read versions of the chapters at:

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The importance of using the MAR/eMAR when administering medications

Safety-Wire-Icon-small-(1).jpg  The medication administration record (MAR) or electronic medication administration record (eMAR) is a vital tool to use when administering medications. Yet, ISMP repeatedly receive reports of errors during medication administration in which the failure to verify the drug using the MAR, eMAR, or medication order was a root cause of the error. Read More

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Avandia, not Coumadin

Safety-Wire-Icon-small-(1).jpg  Last month, the US Food and Drug Administration (FDA) notified health professionals about its decision to remove the prescribing and dispensing restrictions for rosiglitazone-containing drugs, including AVANDIA (rosiglitazone), the combination product AVANDAMET (rosiglitazone and metformin), and generics ( id=1648). Read More

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Could this happen at your facility?

Safety-Wire-Icon-small-(1).jpg  A used oxymetazoline nasal spray was inadvertently placed back in storage with unused oxymetazoline nasal sprays for house stock. Read More

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ICP Of Tiffin And Mason Awarded Accreditation From The Joint Commission

ICP of Tiffin and Mason, Ohio, announced that it has earned The Joint Commission’s Gold Seal of Approval® for Home Care Accreditation by demonstrating continuous compliance with its performance standards. The Gold Seal of Approval® is a symbol of quality that reflects an organization’s commitment to providing safe and effective care.  

Nurses ranked most trustworthy profession

Nurses have been voted the most honest and ethical profession for the 14th year straight in a December 2015 Gallup poll, earning 17 percentage points above any other profession. Read More

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Jody Bouillon of ICP, Inc. Awarded CEAL Certification

Jody Bouillon, Director of Medical Supplies at ICP, Inc. has successfully completed the Certified Executive for Assisted Living (CEAL) certification program offered through the Ohio Centers for Assisted Living (OCAL), and has passed the NAB (National Association of Long Term Care Administrator Boards) Residential Care/ Assisted Living Administrators Examination to earn the CEAL designation.

What is Eczema

Eczema is a nonspecific term for many types of skin inflammation (dermatitis).  There are different categories of eczema, which include allergic, contact, irritant, and nummular eczema, which can be difficult to distinguish from atopic dermatitis (AD).  Atopy is a medical syndrome that includes three associated conditions that tend to occur in the same individual: atopic dermatitis, inhalant allergies and asthma.  All three components need not to present in the same individual simultaneously. Read More

CDC announces $20 million to fight prescription drug abuse

The Centers for Disease Control and Prevention recently announced a new program, “Prescription Drug Overdose: Prevention for States,” which aims to invest in 16 states, including Ohio, currently battling an epidemic of prescription drug overdoses. The program will commit $20 million in FY2015 and is part of the U.S. Dept. of Health and Human Services’ Opioid initiative. Read More

Flu Season Is Off To A Slow Start: CDC

The weather outside might be fearful, but the flu season is thankfully tame so far, according to the Centers for Disease Control and Prevention. Recently, via its weekly FluView report, the CDC announced that the “overall seasonal influenza activity is low across the United States.”

The Power of Language

Language plays a crucial role in shaping the culture of aging and aging services in our society. The words we use when talking to and about older persons denote how they are valued, what is expected of them, and where they stand with respect to the speaker. Read More

Partnership to Improve Dementia Care in Nursing Homes

Antipsychotic Drug use in Nursing Homes Trend Update
In 2012, CMS launched the National Partnership to Improve Dementia Care in Nursing Homes with the mission to improve quality of care for nursing home residents living with dementia. This Partnership, that includes federal and state agencies, nursing homes, pharmacy providers, advocacy groups and caregivers, continues to focus on the delivery of health care that is person-centered, comprehensive and interdisciplinary, in addition to protecting residents from being prescribed antipsychotic medications unless there is a valid, clinical indication and a systematic process to evaluate each individual. Read More

FDA Strengthens Warning That Non-Aspirin NSAIDs Can Cause Heart Attacks or Strokes

Changes Apply To Both Prescription and Over The Counter Drugs
The FDA is strengthening an existing label warning that non-aspirin nonsteroidal anti-inflammatory drugs (NSAIDs) increase the chance of a heart attack or stroke. Based on a review of new safety information, the agency is requiring updates to the drug labels of all prescription NSAIDs. Read More

At risk: Obstructive sleep apnea patients

Obstructive sleep apnea (OSA) is a common sleep-related breathing disorder characterized by repetitive, periodic, partial or complete obstruction of the upper airway during sleep, with periods of breathing cessation lasting for more than 10 seconds. Read More

National Alert on Potentially Fatal Dosing Due to Measurement Devices

Recently, a fatal event was reported to the Institute for Safe Medication Practices (ISMP) National Medication Errors Reporting Program in which a nurse confused dosing scales printed on a dosing cup.  Read More

FDA Alert Confusion Between Brintellix - Brilinta

The U.S. Food and Drug Administration is alerting the public that they have received more than 50 reports of confusion between the antidepressant Brintellix (vortioxetine) and anti-blood clotting medication Brilinta (ticagrelor) which have resulted in the wrong medication being prescribed or dispensed.
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Choking vs. CPR: Correlation to Code Status

The 2010 American Heart Association guidelines indicate chest compressions & rescue breathing are given to a choking victim when that person becomes unresponsive.  How do these guidelines correspond with a resident’s selected code status?
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Guidelines For The Treatment Of High Blood Cholesterol

In 2013, the American College of Cardiology and American Heart Association (ACC/AHA) published updated guidelines for the treatment of high blood cholesterol, replacing the previous guidelines, the third report of the Adult Treatment Panel III (ATP III). The new guidelines brought about a paradigm shift in treating high cholesterol based on evidence from randomized controlled trials, meta-analyses, and observational studies. This article will briefly review the current cholesterol guidelines focusing on how they differ from the previous guidelines and the main points that health care providers should take away from them.

Guidelines for Thyroid Disease Screening 

The US Preventive Services Task Force (USPSTF) recently updated its clinical guidelines on screening for thyroid dysfunction. Conflicting with recommendations from the American Thyroid Association (ATA) and the American Academy of Clinical Endocrinology (AACE), the USPSTF still advises against routine screening of thyroid-stimulating hormone (TSH) levels in non-pregnant, asymptomatic adults. Instead, the expert panel recommends targeted TSH screening for patients with certain risk factors.
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Preventing Heart Failure Remission

Congestive heart failure (CHF) affects an estimated 6.5 million Americans and is responsible for more than 1 million hospital admissions each year. Read More

Preventing Hospital Admissions in Long-term Care Patients with COPD

A growing trend in healthcare is the focus on reducing hospital readmission rates among patients with certain disease states. One of these disease states is COPD. Read More

ICP Educators Speak at OHCA Convention

Tue., April 28th 10:00- 11:30
T22: F 314: Soar to New Heights with Pressure Ulcer Prevention
Erin McClure, BSN, RN, WCC

Wed., April 29th 2:30 - 5:30
W29: Don’t Let IJ’s Stop You from Soaring - Half Day Workshop
Mary Burkart, RN
Erin McClure, BSN, RN, WCC

Thu., April 30th 10:30-11:30
R19: Are Your HAI’s Soaring Out of Control?
Mary Burkart, RN

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CMS announces release of 2015 Impact Assessment of Quality Measures Report

Recently, CMS released the 2015 National Impact Assessment of Quality Measures Report (2015 Impact Report)
The 2015Impact Report demonstrates that the nation has made clear progress in improving the healthcare delivery system to achieve the three aims of better care, smarter spending, and healthier people.  Read More

Efficacy of High Dose Influenza Vaccine in the Elderly

In the 1990s, influenza infection caused an average of 36,000 deaths and 226,000 hospitalizations annually. The majority of hospitalizations and deaths occurred in people aged 65 years or older. Clearly, the elderly are especially vulnerable to flu and flu-related complications, but their antibody response after immunization is less robust than that in younger adults. Since December 2009, a high-dose trivalent flu vaccine formulation has been FDA-approved. It contains four times more hemagglutinin per dose than a standard flu vaccine and should provoke a stronger antibody production. It has also been associated with more injection-site reactions and costs more than standard influenza vaccine.
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An Overview of Ohio LPN IV Changes from March 2013, to the end of 2014

In March 2013, new LPN IV Therapy laws took effect that directly affect nursing practice under the Ohio Revised Code (Law), section 4723.18, Some of the highlights from house bill 303 included; Former section 4723.177, ORC, now renumbered as 4723.18, was amended to remove the prohibition of “aspirating any intravenous line to maintain patency.” Thus, LPNs who are IV therapy certified will no longer be prohibited from aspirating an intravenous line when such aspiration is indicated and performed in accordance within the LPN scope of practice and the applicable standards of safe nursing practice as contained in Chapter 4723-4 of the Ohio Administrative Code. Read More

What is the influenza vaccination rate among healthcare personnel (HCP)?

As reported in the September 19, 2014 Morbidity and Mortality Weekly Report (MMWR), overall, 75.2% of HCP reported having received an influenza vaccination for the 2013-2014 season. Increases in influenza vaccination rates between the 2010-2011 and 2013-2014 influenza seasons are notable within all occupational settings, except for in LTC settings. Read More

Coverage Update on  Prevnar and Pneumovax Pneumococcal Vaccines

As indicated in the October 2014 Consultant Connection, both forms of pneumococcal vaccine, Prevnar and Pneumovax, should be routinely administered in series to all adults 65 years or older. This recommendation from the CDC’s Advisory Committee on Immunization Practices is now also reflected in new payment guidelines from CMS. Medicare B now covers one dose of each vaccine, as long as the time interval between the two vaccinations is at least 11 months.
There are more than 90 strains (serotypes) of pneumococcal bacteria.  Prevnar and Pneumovax cover 13 and 23 of these serotypes, respectively. Complete recommendations may be found at:

Promoted to Position of Director of Pharmacy

ICP is pleased to announce the promotion of Chad Orr, RPh to Director of Pharmacy for ICP’s Tiffin division, where he will manage the daily pharmacy operations. Chad graduated from Ohio Northern University with a Bachelor of Science in Pharmacy degree in 2001. Chad began his career at ICP in 2004 and was promoted to Coordinator of Pharmacy Operations in 2010. Chad serves on ICP’s Quality Improvement Committee, and he has managed the implementation of several key technology projects in recent years.
Chad’s excellent record in customer relations and problem solving abilities have been influential in ICP’s growth and are integral to our success in the future. Please join us in welcoming Chad to his new role as Director of Pharmacy. 

Antibiogram Could Improve Antibiotic Effectiveness and Help Address Antibiotic Resistance

Use of “antibiograms” in skilled nursing facilities could improve antibiotic effectiveness and help address problems with antibiotic resistance that are becoming a national crisis, researchers conclude in a new study.

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Difficult Conversation: Tips for Starting a Hospice Conversation

For many health care providers working in assisted living facilities or nursing homes, beginning a conversation about hospice care with a resident or family member can be extremely difficult.  However, as a trusted source of information, you can play an important role in ensuring residents are informed and receive the most appropriate care available to them.

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New Year, New Outlook, New Habits: Welcome 2015!

With 2014 coming to an end, and the holiday season in full force, its time to make 2015 a priority, and why not kick off the new year with a new outlook, instilling new habits.  With organizations promoting healthy lifestyles including; and Healthy People 2020, kicking off a healthy lifestyle is easier than it has ever been.  After all, who doesn’t like easy, and having evidence-based information available makes it a win-win situation for all whether you are a healthcare worker or consumer. 

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Breaking News: National Pressure Ulcer Advisory Panel (NPUAP):New “Hand Check” White Paper Hot off the Press!

On November 21, 2014, the NPUAP sent out in email introducing the newest addition to their white paper library which is titled, “Hand checks: Are They an Effective Method to Monitor Support Surfaces for Bottoming Out?”   To view this white paper, along with other publications, please visit the NPUAP website at:

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Richard Sandilands, ICP Executive Vice President Retires

ICP would like to announce the retirement of Richard Sandilands as Executive Vice President.
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Introducing Craig Meier RPh, ICP Executive Vice President

Craig Meier, RPh will assume the position of ICP Executive Vice President on January 1, 2015 following the retirement of Richard Sandilands. Craig joined ICP 14 years ago as Administrator of Clinical Services, overseeing the medical records, nursing, consulting, and dispensing pharmacy departments.
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Storage of Refrigerated Medications

IIt is important to understand the guidelines and proper storage of refrigerated medications. All medication temperature requirements can be found in the manufacturer’s package insert or directly on the container’s label. If unavailable through the package insert or labeling, storage conditions can be obtained by calling the manufacturer directly or via their website.
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Changes with heparin labels

We recently received a report about a close call involving 30 mL multi-dose vials of heparin containing 1,000 units per mL.

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Helping Them Adapt

Making The Transition To The Nursing Home Easier
Placing an aging parent or loved one in a nursing home does not mean the end of their life or relationships. How can you make this transition easier? Rather than spending energy on feelings of guilt or sadness use that energy to find creative ways to remind your loved one that you still care.
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Future devices for U-500 insulin

A Lilly representative confirmed that two projects are underway in an effort to meet the needs of patients using U-500 insulin.
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CDC Advisers Recommend Elderly Receive Both Prevnar and Pneumovax Pneumococcal Vaccines 

All adults 65 years of age or older should receive the 13-valent pneumococcal conjugate vaccine (PCV13 - Prevnar) in series with the 23-valent pneumococcal polysaccharide vaccine (PPSV23 - Pneumovax), the Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices (ACIP) has decided.
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3,100 patients notified of pen reuse. 

NurseAdviseERR July 2014
Another hospital has issued notification letters to several thousand patients who received insulin doses that might have come from an insulin pen used for multiple patients. The letter recommended that effected patients be tested for hepatitis B virus (HBV), hepatitis C virus (HCV), and human immunodeficiency virus (HIV) as a precautionary measure ( There have been multiple incidents around the US where the possibility of insulin pen reuse involved 1,000 or more patients. There is strong evidence that retrograde travel of blood carrying hemoglobin, red blood cells, and squamous cells into the pen cartridge occurs after injection. Remind practitioners and staff that pen devices should not be used on more than one person even if the needle is changed.

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Everyone Needs a Flu Vaccine...Every Flu Season

Flu viruses are constantly changing, and different flu viruses circulate and cause illness each season. Flu vaccines are made each year to protect against the flu viruses that research indicates will be most common. This is why everyone needs a flu vaccine every season.

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NeutroPhase® Skin and Wound Cleanser

 NeutroPhase® Skin and Wound Cleanser is a proprietary, FDA cleared, 510(k) broadspectrum skin and wound cleanser consisting of pure hypochlorous acid (HOCl) in saline.. In-vitro studies have shown NeutroPhase disrupts bacterial biofilms and eliminates 99.99% of pathogens.

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Hypergel Water Based Wound Dressing

Hypergel Water Based Wound Dressing effectively debrides dry necrosis to a good environment for natural wound healing.

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Hydrocodone Products Moving to Schedule II

The Drug Enforcement Administration (DEA) has issued a final rule imposing stricter regulatory controls and sanctions on individuals who handle hydrocodone combination products (drugs that contain hydrocodone and specified amounts of other substances). 

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Nuedexta-Neulasta mix-ups

When someone suddenly bursts out crying or laughing for no apparent reason, it may be due to a neurologic condition called pseudobulbar affect disorder. It is associated with certain neurologic conditions such as Alzheimer’s disease or other dementias, stroke, traumatic brain injury, Parkinson’s disease, multiple sclerosis (MS), or amyotrophic lateral sclerosis (ALS or Lou Gehrig’s disease). 

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OBN on LPN IV Role

The Ohio Board of Nursing met on September 18, 2014 to hear the public’s questions and concerns related to the LPN role in IV Therapy/Central Venous Access Devices. The feedback was well received and the Board will review in November at the formal meeting for the 5 year rule review on LPN IV therapy. 
So…keep your eyes open for another “draft” which will be voted on at the next meeting. We are excited to hear the final word from the OBN.

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From the hospital to long-term care: Protecting vulnerable patients during transitions of care

More than 3 million Americans will rely on services provided by long-term care (LTC) facilities during the year, and greater than 1.4 million will live in the nearly 16,000 LTC facilities on any given day.  Approximately one-third of these residents will take an average of nine medications daily, significantly increasing the risk of medication errors, particularly during the transition from a hospital to a LTC facility.2-4

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Latta, Ohio delegation send letter to DEA

WASHINGTON, D.C. – U.S. Representative Bob Latta (R-Ohio) has joined Senator Rob Portman (R-Ohio), Senator Sherrod Brown (D-Ohio) and members of the Ohio Congressional delegation in sending a letter to the Office of Management and Budget, urging it to expedite the Drug Enforcement Administration’s (DEA) promulgation of the final rule under the Secure and Responsible Drug Disposal Act. The rule would provide guidelines for the proper disposal of prescription drugs.

EHOB®'s PVC and PVC/PU Materials Resist Bacterial Growth In Mattresses

Bacteria and fungi can flourish almost anywhere organic material can be found. This includes hospitals, retirement facilities and home-care settings. Some of these microorganisms can cause allergic reactions, infection, and even death. Read More

Drug Shortages

FDA takes great efforts, within its legal authority, to address and prevent drug shortages, which can occur for many reasons, including manufacturing and quality problems, delays, and discontinuations.  Read More


Thousands of patients have been adversely affected by the misuse of single-dose/single-use and multiple-dose vials. The misuse of these vials has caused harm to individual patients through occurrences and outbreaks of bloodborne pathogens and associated infections, including hepatitis B and C virus, meningitis, and epidural abscesses. Adverse events caused by this misuse have occurred in both inpatient and outpatient settings, according to the Centers for Disease Control and Prevention (CDC). Read More

 Genes: Does One Size Fit All?

What is Genetic Testing?
One of the newest technologies being looked at for medical purposes is genetic testing. A big push for genetic testing is to help personalize medications for patients. In general, mediations are currently prescribed based on the “average” patient.  Read More

Copier Data Security

Does your facility keep sensitive data — Social Security numbers, account numbers, health records, or background checks? If so, then you’ve probably instituted safeguards to protect that information, whether it’s stored in computers or on paper. That’s not only good business, but it’s required by law. Read More

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Silent Stealers of Sight

Vision loss among the elderly is a major health problem.  Approximately one person in three has some form of vision-reducing eye disease by the age of 65.  The most common cause of vision loss among the elderly is age-related macular degeneration, glaucoma, cataract and diabetic retinopathy.  These diagnoses have been referred as “silent stealers of sight” because they progress so gradually that they are frequently unnoticed until vision loss has become severe.  Like so many medical conditions, early detection is key to effective treatment.  Read More

Docusate Sodium

Docusate sodium has found its way onto a number of constipation protocols in hospital and palliative care settings alike, even with a lack of supportive statistical evidence. Three recent articles have researched whether this medication is truly beneficial to the patient or just adding to their pill burden. Read More

FDA Warns of Next-Day Impairment with Sleep Aid Lunesta (eszopiclone)

On May 15 the Food and Drug Administration (FDA) warned that the insomnia drug eszopiclone can cause next-day impairment of driving and other activities that require alertness. As a result, the recommended starting dose has been lowered to 1 mg at bedtime. Health care professionals should follow the new dosing recommendations when starting patients on eszopiclone. Patients should continue taking their prescribed dose of eszopiclone and contact their health care professionals to ask about the most appropriate dose for them.

Appropriate treatments for agitation and restlessness in hospice patients

Restlessness and agitation are common issues for the terminally ill patient. There are many different terms used to describe restlessness such as terminal anguish, terminal delirium, and terminal agitation. The signs and symptoms of restlessness vary from patient to patient. Read More

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Healthy Feet - Healthy People!

Healthy feet are essential for healthy aging, yet three out of four people develop foot problems as they age
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Tramadol becomes a Controlled Substance on September 1st

Effective September 1, 2014, tramadol and products containing tramadol will be classified as Schedule IV controlled substances in the state of Ohio, pursuant to Ohio Administrative Code 4729-11-03. Read More

Continuing Education Update

ICP is committed to exceeding our customers’ and employees’ expectations through quality healthcare service, continuous education and effective communication. Read More

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In the near future, you will see two new drugs being promoted for treatment of depression.  Both Brintellix (vortioxetine) and Fetzima (levomilnacipran) were approved in 2013 by the U.S. Food and Drug Administration (FDA) for the treatment of Major Depressive Disorder (MDD) in adults.  Many of you may wonder where these new agents will fit in for treatment of depression.  In order to answer this, let’s take a brief review of depression and the antidepressants currently available. Read More

Microsoft XP Support Termination, HIPAA Security Rule

As of April 8, 2014, Microsoft has terminated support, including the provision of security updates and patches, for Windows XP. Some warnings about the Microsoft termination have threatened that the use of a Windows XP computer after April 8, 2014, is an automatic HIPAA violation, and have advised health care providers that are HIPAA covered entities to immediately upgrade to remain in compliance. Guidance from HHS, however, makes it clear that the Security Rule does not have any mandated minimum requirements for personal computer operating systems. Rather, the Security Rule designates requirements for information systems that contain electronic protected health information (“ePHI”), and gives covered entities flexibility as to how they will implement specifications such as audit controls, user identification and authentication, transmission security, and periodic updates, to comply with technical safeguard requirements. Covered entities must assess and analyze their particular risks, including any known security vulnerabilities, and then consider and implement the safeguards that are reasonable and appropriate in their environment. Therefore, while immediate upgrades may not be required, the continuing use of an unsupported Windows XP system should certainly be part of a covered entity’s risk analysis, and covered entities may need to update as the risks associated with that system increase.

Benefits of a Healthy Mouth

Maintaining good oral hygiene is an important part to overall health and well-being.  Brushing, flossing, and seeing your dentist regularly are some of the easiest ways to keep your mouth healthy. Regular check-ups help recognize changes in the mouth. A healthy mouth can boost confidence and self-esteem, preserve your memory, decrease your risk of heart disease and reduce risk of infection and inflammation in the body. Read More

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Archaic Apothecary Strengths Confused 

The Institute for Safe Medication Practices recently received reports from two different health professionals who expressed concern about the way tablet strength is listed on certain phenobarbital and ferrous sulfate labels. The apothecary measure, grains (gr), is used on the products. Even though the US Pharmacopeial Convention (USP) has banned use of the apothecary system, remnants of it continue to appear on container labels for these and several other products. Read More

New Extended-Release Namenda Compared to Immediate-Release Formulation

In June 2013, it was announced that the new once-daily extended-release formulation of memantine (Namenda XR) would be available to pharmacies in the United States.  The FDA has approved Namenda XR for the treatment moderate to severe dementia caused by Alzheimer’s disease.  Read More


Daliresp (roflumilast) is a phosphodiesterase- 4 inhibitor indicated for the treatment of bronchitis and chronic obstructive pulmonary disease, and is currently the only medication of its kind.  It was approved early in 2011 by the FDA and is therefore approximately$207 per monthly supply.  Read More

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Effectiveness of Calcium Supplements for Treating Hypocalcemia

Many people do not consume anywhere near the recommended amount of calcium in their diets and regularly take calcium (& vitamin D) supplements to maintain normal calcium levels in the body (total calcium: 8.4-10.2 mg/dl; ionized: 3.8-5.3 mg/dl) and to prevent the problems caused by hypocalcemia (i.e. osteoporosis and broken bones).  However, recent studies have indicated questionable efficacy of calcium supplements in preventing bone fractures and they have also been found to potentially cause an increased risk of heart attacks and death.  Read More

Ohio Nurse Practice Act Updates 2013

In March 2013, a new law took effect that directly affects nursing practice in the administration & care of intravenous fluids & medications in adult patients.  Ohio Revised Code, Section Sec. 4723.18, further clarifies the LPN IV therapy courses & permitted tasks. Read More

As U-500 insulin safety concerns mount, it’s time to rethink safe use of strengths above U-100

As the obesity epidemic continues and insulin resistance problems worsen, larger doses of insulin are more frequently required to meet glycemic goals. This has led to an increased use of U-500 insulin when dose requirements exceed 200 units per day. But along with the increased use of U-500 insulin, there are a growing number of U-500 insulin-related medication error reports and/or complaints from health professionals. Read More

Flomax® (tamsulosin) for Urinary Issues in Women

The use of alpha-blockers (tamsulosin, alfuzosin, terazosin, doxazosin) has been the mainstay of treatment for men with benign prostatic hyperplasia (BPH) and lower urinary tract symptoms (LUTS), but little data has been published supporting the use of alpha-blockers in women with voiding dysfunction.  Read More

Gut Microbes Associated with Presence of Rheumatoid Arthritis

New-onset rheumatoid arthritis (NORA) has been found to correlate with presence of Provotella copri microbes in the gut of untreated patients.  Read More

New Treatment Guidelines for Dyslipidemia

The American Heart Association and the American College of Cardiology have released new guidelines for dyslipidemia treatment that will change how medications such as statins are prescribed. Previous guidelines suggested treating to achieve an LDL level of 70mg/dL.  Read More

CE for Nurses

ICP is pleased to announce several additions to our nursing continuing education offerings. Read More

November is National Diabetes Month: A Snapshot of Assessing Diabetic Foot Ulcers

National Diabetes Month is observed each year in November.  This is a time for Associations including; The American Diabetes Association (ADA), National Institute of Health (NIH), and Centers for Disease Control and Prevention (CDC) in partnership with communities across the country – and the world – to shine a spotlight on diabetes and encourage action to change the way diabetes is treated. Diabetes doesn’t stop. It is 24/7, 365 days a year. Read More

Dry Eye Syndrome

Dry eye syndrome is a decreased tears production or increased tear film evaporation over the eye that keeps the eyes lubricated and moist.  Nearly five million Americans 50 years of age and older are estimated to have dry eye.  Tens of million more have less severe symptoms of dry eye syndrome.  Dry eye is more common after menopause however women who experience menopause prematurely are more likely to have eye surface damage from dry eye.
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FDA requiring Color Changes to the Writing on Duragesic Pain Patches

The U.S. Food and Drug Administration is alerting the public that it is requiring color changes to the writing on Duragesic® (fentanyl) pain patches so they can be seen more easily. 
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Indications for Magnesium Oxide and Follow-up

Many elderly patients are being discharged from the hospital on magnesium oxide without a clear indication. These patients also lack a recommendation for follow-up and monitoring while on this medication. Before determining follow-up it is important to find out what magnesium oxide is being used for. Magnesium oxide is specifically indicated for use as a dietary supplement, relief of indigestion and short-term for treatment of occasional constipation. However, since low magnesium levels can cause complications, supplementation can have benefits aside from just achieving normal magnesium levels.  Read More

Melatonin: Does it help in the treatment of insomnia?

Melatonin is involved in many physiologic processes, including circadian rhythms, mood regulation, anxiety, sleep and appetite. Approximately 80% of patients older than 65 years old report sleep-related problems. Melatonin supplementation has become a popular over-the-counter treatment for insomnia. However, there is still a debate on whether this treatment is actually effective.
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Zinc and its Role in Wound Care

Historically the use of zinc for wound care has shown inconclusive results. However, new studies have increasing shown that zinc is an effective therapeutic option for treating wounds. Zinc is an essential trace element that serves many functions. Read More

Effects of Vitamin C on Iron Absorption

Iron is an essential component of many proteins involved in oxygen transport in the human body and also plays an integral part in the regulation of cell growth and differentiation.  Read More

FDA strengthens warnings on long-acting opioids 

In hopes of decreasing opioid abuse, addictions, and overdose deaths, FDA this week announced manufacturer labeling changes for all extended-release and long-acting (ER/LA) opioid analgesics used to treat pain. FDA has also added new postmarket study requirements for opioids such as morphine, oxycodone, and fentanyl. Read More

Fluoroquinolones: Risk of permanent nerve damage

The FDA has required the product labelling for all fluoroquinolone antibacterial drugs be updated to better describe the serious side effect of peripheral neuropathy. This serious nerve damage potentially caused by fluoroquinolones may occur soon after these drugs are taken and may be permanent. Read More

ICP's Growth & Expansion

Established in 1969, ICP has been dedicated to providing services to long term care, assisted living and alternative care facilities. In this ever changing business keeping up with industry, government and reimbursement issues is paramount to our success. Read more

FDA Approves Oral Treatment for Multiple Sclerosis

As of March 2013, the FDA approved Tecfidera (dimethyl fumarate) as a first-line therapy for relapsing forms of multiple sclerosis (MS). Read more

Aspirin in Stroke Patients: Does Dose Matter?

The American Stroke Association (ASA) released their updated guidelines for acute ischemic stroke management this year.  Read more

FDA Releases New Resources, Guidance on Fentanyl Patch Disposal

The Food and Drug Administration (FDA) has updated its guidance on fentanyl patch disposal and created new online resources as part of its “Safe Use Initiative.” Read more


The lie of multitasking
The ability to perform multiple activities at once is usually regarded as an asset. Read more

Acetaminophen Linked to Rare,
Serious Skin Reactions

Acetaminophen products can cause rare but serious skin reactions, FDA announced August 1. Read more

Business Associates and HIPAA Final Rule Compliance Date

At the beginning of the year, the Office for Civil Rights (OCR) of the Department of Health and Human Services published new regulations that extend the privacy and security, enforcement, and breach notification rules under the Health Insurance Portability and Accountability Act of 1996 (HIPAA) and the Health Information Technology for Economic and Clinical Health (HITECH) Act. Read More

Decreasing Heart Failure Readmissions

Overall, 30 day re-hospitalization rates for residents of long term care facilities have steadily risen in the United States. This is largely due to the average hospital length of stay has been reduced and patients discharged to long term care facilities sooner than in the past. Read More

Vitamin D Supplementation

Vitamin D supplementation has become commonplace among adults, with increasing popularity among elderly individuals for a multitude of reasons. Read More

Opioid Induced Constipation

With pain now being monitored as frequently as vital signs, and regulatory standards placing focus on pain management, prescriptions for opioid analgesics increased 700% from 1997-2007. Read More

ICD-10. It’s closer than it seems.

The ICD-9 code sets used to report medical diagnoses and inpatient procedures will be replaced by ICD-10 code sets. The ICD-10 deadline is October 1, 2014. Read More

Primary and Secondary Prevention of Cardiovascular Disease:
Aspirin 81 mg versus Aspirin 325 mg

Currently, cardiovascular disease is the number one cause of morbidity and mortality in the world. The disruption of an atherosclerotic plaque can increase platelet aggregation and eventually form a blood clot that can cause a cardiovascular event, for example a myocardial infarction or a stroke. A drug with anti-platelet effects, such as aspirin, has a substantial impact on morbidity and mortality in patients with cardiovascular disease.  Read More

("I Don't" Beats "I Can't")

"Watch your mouth!" Most of us have heard those three words throughout our lives and on a variety of occasions. It was one of my parent's favorite responses to me when as a child I vigorously registered my discontent with what I perceived to be an unfair situation. Dr. Phil often tells teenagers to watch their mouth when they get 'snarky' with him. We pay attorneys large amounts of money to function as our 'mouth piece' because we fear saying the wrong thing. Read More

Systems Based Approach to a Quality Care Environment

The Centers for Medicare and Medicaid Services (CMS) Department of Health and Human Services issued a memorandum in December 2012 addressing the Nursing Home Quality Assurance & Performance Improvement (QAPI) guide. This guide is detailed to enable nursing homes to understand QAPI principles to begin incorporating these principles into their systems of care by July 1, 2013. Read More

Drugs In the Aging Body: Just What Goes On When You Swallow that Pill?

The elderly are at greater risk of medication misadventures. The reasons behind this fact are multifactorial, and include many things such as physiologic changes, psychosocial issues, economic issues, religious / family beliefs, access to healthcare, complex pharmacotherapy regimens, and understanding of medication use to name a few. This article explores the differences in drug absorption, distribution, and elimination from the body that occur as we age which may or may not influence medication activity.

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Tips to Quench Thirst: Elderly Dehydration Prevention

With spring arriving and the summer months quickly approaching, dehydration prevention is vital to ensure the safety of our residents.  Water is a vital component in the human body. Approximately 60% of the total weight of the body is water, and every system depends on it to function properly. 

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Nursing homes expected to miss 15% antipsychotic reduction goal, but officials focus on progress

Skilled nursing facilities are making progress in reducing the off-label use of antipsychotics but are expected to fall far short of an overall 15% reduction goal.

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FDA Issued Drug Safety Communication - Samsca

The U.S. Food and Drug Administration has issued a drug safety communication to alert healthcare professionals that the drug Samsca (tolvaptan) should not be used for more than 30 days and should not be used in patients with underlying liver disease because it can cause liver injury, potentially leading to liver transplant and death. The FDA has worked with the manufacturer to revise the Samsca drug label to include new limitations.

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FDA Issued Drug Safety Communication - Potiga™

The U.S. Food and Drug Administration has issued a drug safety communication to inform the public that the anti-seizure medication Potiga™ (ezogabine) has been associated with blue skin discoloration and eye abnormalities characterized by pigment changes in the retina. FDA does not currently know if these changes will be reversible and is working with the manufacturer to gather and evaluate all available information to better understand these events.

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Should an ACE Inhibitor (ACEI) ever be combined with an Angiotensin II Receptor Blocker (ARB) or a Renin Inhibitor?

The answer to that question is, very rarely.   Many years ago, physicians combined these medications hoping that by combining them, it would lead to better outcomes.   As it turns out the combination of an ACEI and ARB aren’t beneficial and may actually cause harm.  Read More

Eliquis (apixaban)
A new anticoagulant for treatment of Atrial Fibrillation

In December 2012, Eliquis (apixaban), was approved by the FDA as a new molecular entity (NME) for prevention of strokes in patients with atrial fibrillation (A fib), not caused by a heart valve problem.  Eliquis will join Pradaxa (dabigatran) and Xaralto (rivaroxaban) as alternatives to warfarin (Coumadin and Jantoven) in reducing the risk of stroke. Read More

Look-Alike/Sound-Alike Medications

The below medications are a few of the top offenders of this category. These medications warrant special awareness and consideration when administering the medication due to their potential for medication errors. Read More

Cold or Allergies: How to Tell 

Spring is just around the corner, but don’t be surprised to see winter weather – and viruses – linger a little longer. So what’s behind your stuffy nose: Spring allergies or a cold? Read More

FDA Alert:  Azithromycin- Risk of Potentially Fatal Heart Rhythms

Azithromycin, also known by the trade name Zmax, or Zithromax, is an antibiotic of the macrolide class. The FDA approved indications for azithromycin include acute bacterial exacerbations of chronic obstructive pulmonary disease, acute bacterial sinusitis, community-acquired pneumonia, pharyngitis or tonsillitis, uncomplicated skin infections, urethritis and cervicitis, and genital ulcer disease.
Recently, the FDA has issued a warning that azithromycin can cause a potentially fatal irregular heart rhythm, known as torsades de pointes. Read More

Institutional Care Pharmacy of Tiffin Awarded Accreditation From The Joint Commission

Institutional Care Pharmacy of Tiffin, Ohio has earned The Joint Commission’s Gold Seal of Approval® for accreditation by demonstrating compliance with The Joint Commission’s national standards for health care quality and safety in home care. The accreditation award recognizes ICP’s dedication to continuous compliance with The Joint Commission’s state of the art standards. Read More

Honesty Ratings of Pharmacists Second Only to Nurses!

Three fourths of Americans rated the honesty and ethical standards of pharmacists as “very high” or “high” in Gallup Inc.’s recent poll of the public’s perceptions of various professions. The pharmacy profession finished in second place in the poll, right behind the honesty rating of nurses. Read more

Nursing Role In Reducing Unnecessary Medications

A resident’s drug regimen must be free from unnecessary drugs. That’s what the regulations say, F329 to be more specific. Nurses don’t need regulations to tell us this!  Read more

Skin Basics

Wound prevention is and should be the number one concern in our skin care protocol arsenals for long term care. But when it comes to wound healing, a knowledge of fundamentals is essential.  Basic anatomy and physiology takes priority, then an understanding of the functions of the skin and third the phases of wound healing. Read more

2012 AGS Beers List Update

The Beers Criterion is an evidenced based resource used by healthcare personnel to prevent the use of potentially inappropriate medications (PIMs) in elderly patients as well as what to monitor for in those patients taking these PIMs.  Read More

Osteoporosis Prevention, Detection and Treatment

Osteoporosis Prevention - Recommendations for all ages and populations. Read More

Preparing for Influenza Season

According to the Centers for Disease Control and Prevention Survey, employee vaccination rates in long-term care facilities fell from 64% in the 2010-2011 flu seasons to 52% during the 2011-2012 flu seasons. Read More

Medical Food

For many years patients have joked about taking so many medications that it feels like a meal. Now that Axona, a new prescription food, is available, that joke has now become a reality. Read More

Second Generation Antipsychotics - Better, Not Perfect

Second Generation Antipsychotics (SGAs) have greatly increased our capabilities to care for patients with
psychiatric illnesses. SGAs can often allow patients to live a full productive life with as little interference as possible. Read More

Zostavax: The Shingle Vaccine

Zostavax is the brand name for the vaccine used to prevent the occurrence of shingles.
It is indicated for the prevention of shingles in patients over the age of 50. Read More

Unnecessary Drugs Part 3: Avoiding Citations

Appropriate effective medication regimens are the desired goal for every resident requiring medication therapy. Some words of wisdom from this consultant pharmacist with 24 years of experience…Document, monitor, adjust, document, monitor, adjust, and document some more, then continue to monitor and adjust! Read More

Stop the Rash...Preventing IAD

Incontinence-associated dermatitis (IAD) is a prevalent complication of incontinence that compromises skin integrity, predisposes to cutaneous infection, and increases pressure ulcer risk. Read More

Unnecessary Drugs: Part 2: Situations in which an unnecessary drug citation could be given

This article will incorporate 2 examples for each component of the unnecessary drug definition. Read More

Autumn is in the Air... So is Influenza

The leaves are starting to change colors. Morning air is cool & crisp. Football fans are sporting their team colors. Autumn is here! Unfortunately, autumn is the harbinger of flu season. Read More

Injections Made Easier

Insulin pens have grown in popularity in both home care and healthcare institutions due to the many advantages they offer. Insulin pens are used to inject insulin into the body from a prefilled cartridge. They are easy to use, easy to store and accurate. Read More

Infection Control: Stopping the Spread of Clostridium Difficile

A step by step guide to stopping the spread of Clostridium difficile-associated diarrhea (CDAD). Read More

Unnecessary Drugs: Part 1: Just what is an unnecessary drug?

Many health care workers believe "unnecessary drugs" refers to psychotropic drugs used as chemical restraints. While this is true, the actual definition is much broader since the inception of the term. Read More

Statin Medications No Longer Require Routine Lab Monitoring

In the past, patients have had liver function tests performed prior to starting a statin and then every 6 to 12 months thereafter. New labeling does not require routine monitoring during treatment. Read More

New Drug Update: Dificid

An overview of the product and recommendations for treatment. Read More

Falls - Everyones Responsibility

Studies find that one in five newly admitted nursing home patients has a fall within one month, and that higher levels of staffing with certified nursing assistants reduces the risk of patient falls. Read More

Usage of Flomax in Women

Studies have been conducted to verify the effectiveness of tamsulosin in women with BOO symptoms and have found that tamsulosin is a suitable option for initial treatment. Read More

Mom Hopes Sons Overdose Spurs Prevention Efforts

A grieving mother recently contacted the Institute for Safe Medication Practices (ISMP) about the death of her 2-year-old son, Blake (see photo), from an accidental drug overdose. Her son was not ill, he was not taking any medicine, and he was not hospitalized. Instead, the tragic event began, of all places, at a long-term care facility. Read More

Combating Constipation in the Elderly

Constipation can best be defined as unsatisfactory defecation characterized by infrequent stool, difficult stool passage or both. Read More

Medications to Avoid in Heart Failure

Heart failure is a significant disease state in the elderly population. The main goal in this patient population is to prevent acute exacerbations. These patients are more sensitive to changes in fluid status and sodium retention than other patients. Read More

All Is Not As It Seems

Caution: drug names that end with the letter 'L.' Read More

Attention: Section M Skin Conditions Item Set Changes

Beginning April 1, 2012, Changes/Updates to MDS 3.0 Section M have been implemented... Read More

Acid Suppression Therapy linked to C Diff Infections

Hospitalized patients on an acid suppression regimen are at an increased risk of developing Clostridium difficile associated diarrhea (CDAD) according to two recent retrospective analyses and one prospective cohort study published in the Archives of Internal Medicine. Read More

Five Things Physicians and Patients Should Question

Nine medical societies have each issued a list of five procedures or tests that physicians and patients should question. This initiative is being sponsored by the American Board of Internal Medicine Foundation. Read More

New Once Weekly Treatment Option for Type 2 diabetes

The FDA has approved an extended release form of Byetta, under the brand name Bydureon. It is the first ever once weekly treatment for type 2 diabetes. Read More

Nursing Consideration for the Patient Taking Anxiolytics

Some patients suffer from anxiety, an unpleasant experience. This is an emotional state defined by  psychological and physiological responses to the anticipation of real or imagined danger. Read More

Multi-Dose Vials

Administering parenteral medications has become routine for nurses across the healthcare spectrum. Subcutaneous, intramuscular, intravenous, or intradermal routes all provide medications in a specific manner. These medications are dispensed in vials, some of which are single use, others multi-dose. Read More

FDA News Release

FDA Announces Safety Changes In Labeling For Some Cholesterol-Lowering Drugs Important safety changes to the labeling for some widely used cholesterol-lowering drugs known as statins are being announced today by the U.S. Food and Drug Administration. Read More

Comparing Anticoagulants for treatment of Atrial Fibrillation

AFib is a type of irregular heartbeat.  AFib affects more than 2 million people in the United States. When your heart beats irregularly, it doesn’t pump blood as it should. This can cause blood to pool in the upper chambers of your heart (called the atria)thus causing a clot which can ultimately cause a stroke. Strokes can be prevented in most AF patients by using anticoagulants, or blood thinners. Anticoagulants reduce your blood’s ability to clot (coagulate). Read More

Can Vitamin C Be Used to Prevent Urinary Tract Infections

The urinary tract is one of the most common sites of bacterial infections in humans. Numerous bacterial organisms may be the cause of urinary tract infections, but the most common pathogen is E. Read More


Nuedexta is a newly approved drug for pseudobulbar affect (PBA). Pseudobulbar affect occurs when certain neurologic diseases damage the area of the brain that controls emotion such as Multiple Sclerosis, Parkinson’s Disease, or stroke. Read More

COPD Management

Chronic Obstructive Pulmonary Disease (COPD) or Chronic Obstructive Lung Disease (COLD) is the most common lung diseases in our society. COPD is a term used to describe a disease that interferes with normal breathing and gets worse slowly over time. Here is some information and suggestions on how to manage COPD. Read More

Future EHR users

Announced on December 15, 2011 for the first time in Ohio, a hospital is "live" on the statewide health information exchange (HIE)-CliniSync. Clinical patient data is moving from St Rita's Medical Center in Lima to Health Partners of Western Ohio, a federally qualified health center, right into the physicians' electronic health records (EHR) system. Read More

Yeilding Concerns on Yaz

If you’ve watched television lately you’ve likely seen the legal commercials regarding Yasmin, Yaz, or Beyaz in relation to blood clots. In order to decipher the information about the above mentioned  medications you must first understand what these drugs are. Read More

Simple Wound Care Time Saving Tips

Many nurses who are performing the care of wounds are spending too much time. Good wound care does take some time. We should be better prepared and I hope to guide you to save some time in caring for the wounds you manage. Read More

Defend Against Fraud

To guard your personal information, here are 8 simple tips to follow. Read More

Bedtime Dosing of Blood Pressure Medications

There is new evidence that suggests that giving at least one blood pressure medication at bedtime improves BP control and therefore decreases cardiovascular events in some patients. Read More