The digital age has forever altered our lives for the good and also the bad by opening up people to threats that are hard to predict. As technology evolves, so do the cunning tactics of cybercriminals. From sophisticated scams targeting banks to stealthy phishing emails, the landscape of cybersecurity threats is vast and ever-changing.

At Rpharmy, we've experienced firsthand the increasing intricacies of these threats. A seemingly innocuous email was sent to one of our junior team members, appearing as if it came directly from me, the CEO. This tactic, known as CEO fraud or Business Email Compromise (BEC), is an insidious form of social engineering. Here, cybercriminals cleverly manipulate employees to spill sensitive information.

A leading cybersecurity firm, Phished, points out that in such scams, criminals impersonate high-ranking officials to exploit unsuspecting employees. Their modus operandi may range from orchestrating wire transfers and creating fake invoices to asking for bank or payroll details. Shockingly, this scam has a pervasive reach, spanning across all 50 states and 150 countries.

At Rpharmy, the initial request might have seemed benign – merely asking for a phone number. Yet, this seemingly small piece of information can be the gateway to more consequential data breaches. It's alarming to note that many colleagues, their families, and friends have reported being targeted with variations of this scam, including buying gift cards and divulging payroll account numbers.

And the risks don't just end there. Ransomware attacks compromise organizations crucial to our society's functioning - water facilities, government buildings, and, most concerningly, healthcare facilities. The data these institutions hold, especially healthcare data, is among the most sensitive. It's a treasure trove for cybercriminals, allowing them to execute fraudulent Medicare and Medicaid claims and expensive treatments.

At Rpharmy, while we don’t store patient-specific information, we're acutely aware of the ramifications if malicious entities access a hospital’s medication resource data via platforms like Formweb or Rhazdrugs. Such breaches could directly jeopardize patient care and safety.

Given the magnitude of these risks, we’ve fortified Formweb and Rhazdrugs with state-of-the-art authentication procedures, including two-factor authentication. And, because we believe in continuous improvement and transparency, here's a little inside scoop: We are in the midst of enhancing the user experience across our platforms. This initiative isn’t just about usability; it’s about harnessing cutting-edge technology to provide our users with the most secure environment possible.

In this era of relentless cyber threats, we at Rpharmy pledge to stay vigilant, proactive, and committed to safeguarding your trust. If you are ever concerned about the safety of your Formweb or Rhazdrugs sites, please contact us directly at (800) 467-1907. 

As the Manager of Pharmacy Contract-Utilization for standalone clinics and hospitals within the growing Ochsner Health system, Charlotte Dixon uses Rpharmy’s Formweb as a source of truth when evaluating drug and formulary requests from clinicians and hospitals.

Formweb is the cloud-based medication resource platform trusted by Ochsner to house system-wide formulary and safety information for their multi-state system of hospitals and clinics. 

Clinic Requests
When clinics contact Charlotte asking if they can prescribe a specific drug to patients, Charlotte first checks with Formweb. 

“I try to do pre-work before escalating clinic requests to the MUSE (Medication Use Safety and Education) team. I check Formweb to see if these items are formulary and if they are approved for what the clinic needs,” Charlotte said.

The MUSE team works with many constituents within the extensive Ochsner system - both within the clinics and the hospitals - to evaluate drugs, review existing drugs for updates, document safety requirements and determine the education necessary for the drug to be used at their facilities. 

Before sending the drug request to the MUSE team, Charlotte checks for these things in Formweb: 

1. Is it formulary?
2. Is it approved in this service line? 
3. Is all drug information accurate? 
4. Has anything changed with this drug?  
5. Are any approvals in process for this drug? 

Depending on the answers, Charlotte either approves the clinic’s drug request or can work with the requester and MUSE to file a formulary request. 

For example, a clinic requests a drug for a specific procedure. Charlotte reviews Formweb for Ochsner’s policies and requirements when administering this drug. She can also access the vendor requirements that must be fulfilled before the provider can access the requested drug. By accessing all of this information quickly in Formweb, Ochsner’s single source of medication information, Charlotte can provide accurate information and help prevent med errors or any other accidental risk.

Also, as new clinics join the system, Formweb makes it easy to evaluate the new clinics’ drug lists and provide the safety information needed for those drugs. She can also determine what service line their drugs have been approved for or if there is an exception and add them to Formweb accordingly. Formweb also ensures a consistent record of drugs and documentation when employees leave or move positions, which reduces the risk that someone accesses or administers a drug in an unapproved or harmful way. 

Integrating New Hospitals
Charlotte also manages contracts and purchasing for Ochsner’s hospitals. This includes existing and newly acquired hospitals joining the Ochsner system-wide formulary. As new hospitals integrate their formulary or request drugs not in the Ochsner formulary, Charlotte refers to Formweb throughout the process. 

Charlotte says that with Formweb, she can walk new hospital staff through the process of checking for the drug and then requesting it if it’s not already approved in the formulary. Because it is the single source of truth, she feels confident that she can provide the most up-to-date and accurate drug information to all of her constituents so they can then make the best decisions for their patients. 

In a recent example, a clinician requested a drug where one of the indications required REMs (Risk Evaluation and Mitigation Strategy) and one indication did not. Charlotte referenced Formweb to verify that the drug was on the Ochsner formulary and, if so, review which indications were approved and what safety requirements were listed. She did confirm that their formulary did include the requested drug - one indication was labeled with REMs and another was not. Because Formweb includes the ability to label drugs with REMs as well as specific safety information, Charlotte was able to communicate this critical safety information to the clinic. 

Formweb also reduces the time spent by doctors requesting a drug. By checking Formweb when a doctor requests it, Charlotte can provide the information needed to enable the doctor to make a vital treatment decision. Suppose the initial drug is not in the Ochsner formulary. In that case, the doctor can determine if it is worth the time to put in the request, which may mean taking a risk that the drug will not be approved for formulary or, even if approved, might result in a significant delay of patient treatment. Based on the information Charlotte provides from Formweb, the doctor may need to seek other treatment options. 

Bottomline: 
Because all of their formulary information is housed alongside safety information and policies, Formweb saves Charlotte time and creates efficiencies as she collaborates with other teams across the Ochsner Health system, including MUSE, clinicians, and pharmacists, to review and approve drug requests.

Our Safety First blog on “Should, Shall and Must,” as used in the USP <800> hazardous drug safety requirements, continues to be one of our most searched-for and visited blogs. Therefore,  we decided to write another blog exploring the topic in a little more depth to hopefully provide additional guidance on a topic that still causes confusion and concern. 

As you are well aware, ensuring safety in healthcare facilities goes beyond patient care; it also involves the important work of protecting healthcare workers from hazardous drug exposure. However, in an age of digital health and advanced technology, it's alarming that there are still healthcare professionals who resort to scouring the internet for safety information when dealing with hazardous drugs. This poses risks not only to their health but also to the overall safety standards of healthcare environments.

We know that since the USP <797> and USP <800> deadline was announced, November 1, 2023, has loomed large in the minds of hospital leaders, especially among pharmacy directors.  In our many conversations with customers working to comply with the hazardous drug safe handling guidelines, we’ve learned most are still working towards compliance. In fact, in a Rpharmy survey, most did not feel ready for inspections around USP <800> guidelines. 

More than 12 billion doses of hazardous drugs are handled per year, according to NIOSH. Each handling instance represents multiple opportunities for exposure - from the initial receiving of the drug to clinical administration and finally to safe disposal. 

USP <800> establishes comprehensive protocols to ensure the safe handling of hazardous substances throughout their lifecycle, encompassing everything from initial reception and unpackaging by pharmacy staff to the administration by clinicians and final disposal in environmental services. The guidelines provide detailed instructions for disposal methods, ranging from basic waste disposal in designated containers to effectively managing incidents involving potentially hazardous spills, such as vomit. 

USP <800> is set to be enforceable starting November 1, 2023, prompting hospitals and healthcare facilities to expedite their compliance plans. This entails updates to facilities, policies, and processes, along with effective communication to all healthcare workers exposed to hazardous drugs. However, ensuring that your USP <800> hazardous drugs safety solution is reliable can be a challenge. In this blog, we will discuss five essential attributes to consider when evaluating your USP <800> safe handling solution.

Since the publication of “NIOSH List of Antineoplastic and Other Hazardous Drugs in Healthcare Settings, 2016” (NIOSH 2016), healthcare systems and facilities have been referring to Table 5 for hazardous drugs (HDs) safe handling guidance based on the activity and the formulation of the medication. Like the USP <800> mandate, the NIOSH 2016 directives in Table 5 were broad and provided general PPE instructions for the different types of HDs, including cancer chemotherapy, antivirals, and hormone therapies. In fact, NIOSH stated in the document: “This guidance does not cover all possible situations but provides general recommendations for the typical handling situations in healthcare.” 

In May 2023, NIOSH released an updated document to expand on NIOSH 2016 Table 5 called “Managing Hazardous Drug Exposures: Information for Healthcare Settings.” In this additional guidance, NIOSH provides more in-depth HD assessment information and safety guidance throughout the document, including specific PPE and safe handling recommendations. 

Notably, the new PPE safe handling table located in Chapter 8 is now organized by “Activity” and then “Formulation” vs. the reverse in NIOSH 2016. This new organization makes it simple to scan for the activity the healthcare worker will be involved in, like “disposal and cleaning,” and then determine the safety precautions needed based on formulation like “drug-contaminated waste.” The engineering controls are also clearly labeled and include Closed System Drug Transfer Device (CSTD) recommendations. In some activities and formulations, NIOSH has expanded on a previous “No” to say “No, unless a leak is observed or suspected,” for example. 

While the new document doesn’t cover all exposure situations, it goes further to provide extensive risk management guidance and more context for various types of HDs and PPE required for everyday activities. 

Integrating Chapter 8 into Your Organization

The Pharmacy can update PPE, engineering, and CSTD information in the formulary or hazardous drug list to provide more direction and protection to healthcare workers. The CDC cites that more than 8 million healthcare workers are exposed to HDs each year; how does your organization communicate the PPE required to protect healthcare workers from dangerous exposure? 

Rpharmy provides a range of options for communicating PPE requirements, including simple text instructions such as 'Double chemotherapy gloves' or universally understood icons. Here’s an example of a facility that uses text and imagery to clearly communicate which PPE to use. 

It’s 2023, and healthcare systems are still only required to document and communicate safety guidelines for hazardous drugs on the NIOSH 2016 list … In the meantime, the NIOSH 2020 list is available but is still not the required point of reference for hazardous drug (HD) lists. However, NIOSH 2016 may soon be out and NIOSH 2020 may soon be the law of the land under the name: NIOSH List of Hazardous Drugs in Healthcare Settings 2023. The updated list will be official once the Federal Register reviews and approves it, although we still don't have an estimated date. Until then, we are still referencing NIOSH 2016.