CONTACTS 

SUBJECTS
Neupogen Injection Medical Mistakes Treatment Failed Need Prescripti

1303 -
1303 -    ..
1304 - Summary/Objective
1305 -
130501 - Follow up ref SDS 77 0000. ref SDS 76 0000.
130502 -
130503 -
130504 -
130505 -
130506 -
130507 -
130509 -  ..
1306 -
1307 -
1308 - Progress
1309 -
130901 - This morning about 1130, we arrived home from Lafayette Reservoir
130902 - after Millie hiked two (2) laps, about 5.5 miles, in 130 minutes.
130903 - This was her best time ever, and reflects efforts to increase exercise
130904 - applying the doctor's explanation on 030606 that vigorous exercise
130905 - helps increase blood counts, ref SDS 2 O44J, essential for cancer
130906 - treatments, also, explained on 030606. ref SDS 2 JP7G
130908 -  ..
130909 - There was a message on the telephone answering machine from the
130910 - primary care physician at Kaiser.
130912 -  ..
130913 - The doctor's message said that today he received Millie's letter,
130914 - ref DIP 1 0001, submitted on Saturday, 080607 explaining the mistake
130915 - with self-injection that caused loss of a Neupogen treatment, and so
130916 - requires replacement for treatment today, ref SDS 77 TO5N, as
130917 - prescribed by UCSF on 080605, and is needed in time for Millie to get
130918 - treatment at UCSF on Thursday.  The doctor also received Mil's follow
130919 - up letter, ref DIP 2 0001, using the Kaiser speical email system,
130920 - ref SDS 77 QG9J, that re-stated the problem and confirmed request for
130921 - 1 Neupogen treatment in the Infusion Clinic to make up for the loss of
130922 - the treatment due to patient error. ref SDS 77 TO5N
130924 -  ..
130925 - The doctor said he placed the order for Neupogen treatment, but there
130926 - was confusion using Kaiser's computer system, so he is not sure what
130927 - will happen with the order.  He tried calling the Pharmacy to clarify
130928 - the order, but was on hold waiting to get the right person, and so had
130929 - to hang up to attend a meeting.  The doctor said to let him know of
130930 - any problems, and he will make adjustments to ensure effective care,
130931 - similar to the order for Neupogen last month on 080502, when the
130932 - computer system for ordering prescriptions seemed to be like a "black
130933 - box" of uncertaiinty. ref SDS 70 NM3M
130934 -
130935 -            [...below, Zan in Oncology Pharmacy reported that everybody
130936 -            is confused by complex health care procedures. ref SDS 0
130937 -            027G
130939 -             ..
130940 -            [...below, Mellanie in Outpatient Pharmacy reported mistake
130941 -            using computer, ref SDS 0 IS47, indicated Neupogen
130942 -            transaction seems confusing. ref SDS 0 IS61
130944 -             ..
130945 -            [On 080628 Kaiser protocol requires Millie get 2 shots of
130946 -            240 mg for Neupogen prescribed by UCSF indicates confusion
130947 -            and error by Outpatient Pharmacy providing treatment in 1
130948 -            shot of 480 mg. ref SDS 84 Q74G
130950 -  ..
130951 - Millie also received a letter from the doctor using Kaiser's special
130952 - email system, saying simply...
130953 -
130954 -    1.  RE: Neupogen Treatment GoofPrinter-friendly version
130962 -         ..
130963 -    4.  Received:
130964 -        6/9/08 9:45 AM
130966 -         ..
130967 -    5.  Filled. Left you a message. [per above, ref SDS 0 837J]
130968 -
130969 -            [...below, Zan in Oncology Pharmacy called and advised that
130970 -            the doctor changed the prescription to avoid mistakes with
130971 -            Neupogen treatments. ref SDS 0 IL6I
130972 -
130976 -
130977 -
130979 -  ..
1310 -
1311 -
1312 - 1139
1313 -
131301 - Millie was confused about what to do to get the Neupogen treatment
131302 - which UCSF says must be taken today in order to get chemotherapy
131303 - treatment on Thursday.  She wrote a letter responding to the doctor
131304 - saying...
131306 -             ..
131307 -            [...below, Zan reported that everybody is confused by
131308 -            complex health care procedures. ref SDS 0 027G
131309 -
131310 -    1.  Neupogen Treatment
131312 -         ..
131318 -         ..
131319 -    4.  Sent:
131320 -        6/9/08 11:44 AM
131325 -         ..
131326 -    6.  Thanks for following up to solve the Neupogen problem.
131327 -        ref SDS 0 TZ8I
131329 -         ..
131330 -    7.  The pharmacist told me on 080502, that you can prescribe
131331 -        treatment with Neupogen in the Infusion Clinic and this reduces
131332 -        my cost. ref SDS 70 HF82  As you may know, Neupogen is very
131333 -        expensive.  Going forward, I will likely need 2 treatments per
131334 -        week for 3 weeks each 4 week cycle.  If that proves inadequate
131335 -        this will be increased to 3 treatments.
131337 -         ..
131338 -    8.  I would like this work done in the Infusion Department to avoid
131339 -        application errors, as occurred this past Saturday, reported on
131340 -        080607, ref SDS 77 Q67I, and for cost containment.  I saw
131341 -        Diana, who works in the Infusion Clinic at Kaiser Walnut Creek,
131342 -        at a recent Wellness Community event a few weeks ago.  I asked
131343 -        about getting Neupogen treatments.  She said they do it all the
131344 -        time.  It only takes a couple of minutes, and so does not tie
131345 -        up nursing staff.  Another patient sitting next to me at UCSF
131346 -        last week said she comes in to get Neupogen a few days after
131347 -        her chemo.  This saves a lot of money.
131348 -
131349 -            [...below, Millie was charged $2,000 for 6 Neupogen
131350 -            treatments in order to get 1 treatment prescribed as
131351 -            essential in order for Millie to get cancer treatment on
131352 -            Thursday. ref SDS 0 028F
131354 -             ..
131355 -            [On 080628 Kaiser protocol requires Millie get 2 shots of
131356 -            240 mg for Neupogen prescribed by UCSF indicates confusion
131357 -            and error by Outpatient Pharmacy providing treatment in 1
131358 -            shot of 480 mcg. ref SDS 84 Q74G
131360 -         ..
131361 -    9.  Can you help?
131362 -
131363 -            [...below, Zan in Oncology Pharmacy called and advised that
131364 -            the doctor changed the prescription to avoid mistakes with
131365 -            Neupogen treatments. ref SDS 0 IL6I
131366 -
131367 -            [...below, Zan reported that everybody is confused by
131368 -            complex health care procedures. ref SDS 0 027G
131369 -
131377 -  ..
131378 - After sending the letter, Millie tried to call the doctor and possibly
131379 - talk to Arlette, who has been helpful coordinating things on past
131380 - issues.
131382 -  ..
131383 - Arlette is not working today.  Talked to another nurse, who said the
131384 - doctor is on "campus," but not in his office.  She will tell him
131385 - Millie called.
131386 -
131387 -
131389 -  ..
1314 -
1315 -
1316 - 1219
1317 -
131701 - Since time was running out getting Neupogen treatment for today in
131702 - order to get her chemotherapy treatment at UCSF on Thursday, and since
131703 - the doctor had not had time to call back or write to clarify where
131704 - Millie should get the Neupogent treatment needed today, and since UCSF
131705 - had proposed a solution, requested in Millie's letter on 080607,
131706 - ref SDS 77 YQ6U, she therefore wrote again to the doctor at Kaiser
131707 - saying...
131708 -
131709 -    1.  Neupogen Treatment Plan
131717 -         ..
131718 -    4.  Sent:
131719 -        6/9/08 12:26 PM
131720 -
131724 -         ..
131725 -    6.  I tried returning your call to supplement the reply a few
131726 -        minutes ago.  Was unable to reach you or Arlette, because she
131727 -        is off today. ref SDS 0 4R6J
131729 -         ..
131730 -    7.  I am going to go ahead and get the Neupogen treatment you
131731 -        ordered at the Pharmacy for today.  Thanks very much for timely
131732 -        support.
131734 -         ..
131735 -    8.  I don't get Carbo next week. I have a meeting with you at
131736 -        Kaiser the following Friday when I start the next cycle.  The
131737 -        Chemo Orders I get from UCSF on Thursday can guide your
131738 -        prescription.  I assume it will continue 2 Neupogen treatments.
131739 -        This is tricky because they want it on day 2 and day 3.  If day
131740 -        2 is Friday that works to get treatment in the Infusion Clinic;
131741 -        not sure about Saturday and Sunday.  Doctor Rugo says we can
131742 -        delay until Monday. If we can do Fri and Mon, or even Mon and
131743 -        Tues, then we can set up an order for all three weeks in the
131744 -        Infusion Clinic.
131746 -         ..
131747 -    9.  Hope this works and not too confusing.
131749 -         ..
131750 -   10.  Please call me back to clarify planning at
131752 -
131753 -            [...below, Zan in Oncology Pharmacy called and advised that
131754 -            the doctor changed the prescription to avoid mistakes with
131755 -            Neupogen treatments. ref SDS 0 IL6I
131756 -
131763 -
131765 -  ..
1318 -
1319 -
1320 - 1230
1321 -
132101 - Millie drove to Kaiser in Walnut Creek to try and get the treatment.
132102 -
132103 -
132104 -
1322 -

SUBJECTS
Neupogen 1-Treatment Needed 080609 Notify  Pimary Care Physician Usi

2603 -
2604 - 1257
260501 -  ..
260502 - Neupogen 480 MCG Prescription Required NLT 080609 Notify Kaiser
260503 -
260504 - Follow up ref SDS 77 IL6I.
260505 -
260506 - Zan, the Oncology Pharmacist, called.  He advised that Millie's
260507 - primary care physician has ordered Neupogen 480 mcg treatments in the
260508 - Infusion Clinic to maintain blood counts for Millie to get Carboplatin
260509 - combined with cetuximab, and prescribed by Doctor Rugo at UCSF in
260510 - Chemotherapy Orders dated 080529. ref SDS 75 PWSY
260512 -  ..
260513 - Zan said the doctor called him and asked that Zan call Millie to
260514 - advise that this prescription will correct mistakes cited in the
260515 - doctor's phone message this morning, per above, ref SDS 0 837J, and
260516 - will also resolve problems reported in Millie's letter to the doctor,
260517 - per above. ref SDS 0 1U3X  Zan explained that treatment in the
260518 - Infusion Clinic at Kaiser in Walnut Creek ensures quality care by
260519 - trained professionals that avoid confusion on 080501, when the
260520 - prescription for 2 treatments, ref SDS 68 SR5M, was changed to 1.
260521 - ref SDS 68 M658, More recently, on 080529 1 Neupogen treatment was
260522 - prescribed, ref SDS 75 TE6N, but a week later on 080605 the
260523 - Chemotherapy Orders showed that actually 2 treatments were prescribed,
260524 - ref SDS 76 JN38, leading to mistakes from self-injections at home that
260525 - cause loss of medication drugs and delay treatment, as occurred on
260526 - Saturday, 080607, ref SDS 77 Q67I, and reported to the medical team in
260527 - a letter later that day on 080607. ref SDS 77 TO5N
260529 -         ..
260530 -        [On 080628 doctor's order for treatment in Infusion Clinic
260531 -        corrects confusion and error by Outpatient Pharmacy providing
260532 -        Neupogen treatment with 1 injection of 480 mcg; Kaiser protocol
260533 -        requires Millie get 2 injections of 240 mcg each. ref SDS 84
260534 -        Q74G
260536 -  ..
260537 - Previously, On 050415 Zan supported Millie's care explaining treatment
260538 - with capecitabine (Xeloda), ref SDS 4 PS6X, and reviewing drug
260539 - documentation on side effects. ref SDS 4 BU67   At that time on 050415
260540 - Zan recommended the patient keep a diary of medical history to support
260541 - the doctor patient partnerhip for quality care. ref SDS 4 XT5F  Zan
260542 - was effective on 050415 coordinating with the primary care physician
260543 - to correct mistakes and clarify prescription for Neupogen to treat
260544 - problems of low blood counts. ref SDS 4 KX49
260546 -  ..
260547 - Today, Zan scheduled treatments in the Infusion Clinic correlated to
260548 - Millie's chemotherapy treatments with Carboplatin at UCSF, as planned
260549 - in the letter to the medical team on 080607, ref SDS 77 YQ5U, and
260550 - explained again in a letter to Kaiser earlier today, per above.
260551 - ref SDS 0 1U3X  Zan asked when Millie will need Neupogen treatments?
260553 -  ..
260554 - We reviewed the record showing that on 080612 Millie gets the 3rd
260555 - treatment with Carboplatin in the current 4th cycle.  The next week on
260556 - 080619 she gets the 4th treatment in the 4th cycle which is a bye week
260557 - for Carboplatin, so she gets only cetuximab.  The following week on
260558 - 080626 Millie starts the 5th cycle in the 2nd arm of the clinical
260559 - study with both cetuximab and Carboplatin.  If blood counts are low
260560 - for the 4th treatment of the 4th cycle on 080619, then the doctor may
260561 - prescribe Neupogen in order to increase chances that Millie can get
260562 - treatment to start the 5th cycle on 080626.
260564 -  ..
260565 - Zan asked about the Chemotherapy Orders?
260567 -  ..
260568 - UCSF Chemotherapy Orders dated 080529 for the 4th cycle call for
260569 -
260570 -        Neupogen 480 mg SQ on D2/D3. ref SDS 75 PWSY
260572 -  ..
260573 - Zan indicated "D2/D3" is medical shorthand for prescribing 2 Neupogen
260574 - treatments and they should be given on Friday and Saturday after
260575 - chemotherapy treatments on Thursday.
260576 -
260577 -            [On 080620 Kaiser's schedule for Neupogent omits 2nd
260578 -            treatment in the Infusion Clinic on 080707 for treatment on
260579 -            080703 due to 4th of July holiday. ref SDS 80 YY50
260581 -             ..
260582 -            [On 080620 Kaiser relies on UCSF letter dated 080620 for
260583 -            documentation, ref SDS 80 YY5H, modifying Neupogen
260584 -            prescription in Chemotherapy Orders dated 080529,
260585 -            ref SDS 80 F67F, and relied on by Kaiser today for ordering
260586 -            Millie's treatments. ref SDS 0 0165
260588 -  ..
260589 - We reviewed discussions with UCSF on 080403.  At that time, the doctor
260590 - seemed to indicate that Neupogen could be delayed until Monday.  This
260591 - provides a window for the patient to get Neupogen from Kaiser on
260592 - Friday, Saturday, Sunday or Monday.  Zan said the Kaiser Infusion
260593 - Clinic is not open on Sunday, but that Friday, Saturday, and Monday
260594 - will work fine to give people flexibility on treatment.
260596 -  ..
260597 - Zan feels the best approach is to set up standing orders for Millie to
260598 - get Neupogen treatment at a convenient time in the Infusion Clinic
260599 - beginning on 080620 and 080621, which is Friday and Saturday after the
260600 - 4th treatment on 080619.  He is scheduling treatment for the next two
260601 - weeks on 080627 and 080628, and again the following week on 080703 and
260602 - 080704, continuing through July.
260604 -  ..
260605 - Zan used the record on 080529 showing the UCSF schedule for Millie's
260606 - chemtherapy treatments in June and July, ref SDS 75 IK7H, to
260607 - synchronize Kaiser's schedule for Milliels 2 Neupogen treatments per
260608 - week, as shown in the Chemotherapy Orders, per above. ref SDS 0 L16I
260609 -
260610 -        [On 080626 UCSF issued updated schedule for chemotherapy
260611 -        treatments through 080904. ref SDS 82 IK7H
260613 -  ..
260614 - Zan asked that Millie support Kaiser quality control practices.  Bring
260615 - the UCSF Chemotherapy Orders to the Infusion Clinic on the day of
260616 - treatment.  Kaiser can make a copy for the medical chart showing work
260617 - performed at Kaiser aligns with the doctor's prescription at UCSF,
260618 - e.g., per above. ref SDS 0 L16I  This fits the model of referral
260619 - coordination planning, discussed at UCSF on 070222. ref SDS 9 VK5N
260620 -
260621 -        [On 080620 Kaiser's schedule for Millie's Neupogen treatments
260622 -        correlate with UCSF's schedule for chemotherapy treatments.
260623 -        ref SDS 80 YY88
260625 -         ..
260626 -        [On 080711 Kaiser updated schedule for Neupogen treatments
260627 -        through August. ref SDS 86 RW3F
260629 -  ..
260630 - Zan explained that, if it turns out that patient blood counts are good
260631 - in the test on 080619, and the doctor does not order Neupogen that
260632 - week, then Millie can notify the Infusion Clinic to cancell Neupogen
260633 - treatments for 080620 and 080621.
260635 -  ..
260636 - Additionally, if patient care requires increasing Neupogen to 3, 4, or
260637 - 5 treatments per week, or decreasing treatment to only 1 per week,
260638 - then UCSF can notify Kaiser with updated Chemo Orders, and Zan will
260639 - update Millie's schedule for Neupogen treatments in the Infusion
260640 - Clinic.
260642 -  ..
260643 - Zan said it is a good idea for Millie to remind Infusion Clinic staff
260644 - when she gets a treatment that she needs treatment the following week.
260645 - He has set up the account to extend as long as needed.
260647 -  ..
260648 - Zan advised that he cancelled the doctor's order in the computer this
260649 - morning entered by mistake for Neupogen sent to the Outpatient
260650 - Pharmacy, reported in the doctor's phone message to Millie, per above.
260651 - ref SDS 0 DH6I  This aligns with Kaiser correcting a previous mistake
260652 - by cancelling an order for Neupogen at the Outpatient Pharmacy on
260653 - 080418. ref SDS 66 EM6G
260655 -  ..
260656 - Zan said that Kaiser quality control requirements prohibit double
260657 - prescription.  Zan feels Millie must return the Neupogen received from
260658 - the Outpatient Clinic, because duplicate treatments cause confusion
260659 - that increases risks of over-medication, leading to complications,
260660 - even death.
260661 -
260662 -        [On 080628 Kaiser protocol requires Millie get 2 shots of 240
260663 -        mg for Neupogen prescribed by UCSF indicates confusion and
260664 -        error by Outpatient Pharmacy providing treatment in 1 shot of
260665 -        480 mg. ref SDS 84 Q74G
260667 -  ..
260668 - Zan commented that Pharmacy rules are very complex.  Frequent changes
260669 - in regulations and computer procedures has everybody confused about
260670 - what to do, so people in various departments implement conflicting
260671 - procedures based on impressions from the latest memo, staff meeting,
260672 - or seminar.  This aligns with the primary care physician reporting on
260673 - 070916 that health care regulations are constantly changing,
260674 - ref SDS 20 QY96; confusion was cited again in the phone message this
260675 - morning, per above, ref SDS 0 837J, and citing a prior report on
260676 - 080502 that ordering medication presents a "black box" mystery about
260677 - what results will actually occur. ref SDS 70 NM3M  Challenges using
260678 - computers for health care case management are shown in a case study on
260679 - 061024. ref SDS 6 QJ4G
260681 -         ..
260682 -        [...below, Mellanie in the Outpatient Pharmacy reported
260683 -        problems and confusion using the computer. ref SDS 0 IS55
260685 -  ..
260686 - Zan suggested that when Millie gets home from Kaiser with Neupogen
260687 - from the Outpatient Pharmacy, she go back to Kaiser and explain the
260688 - problem.  He feels there is a "shot" they will take the Neupogen
260689 - treatments back for quality control to correct the prescription
260690 - mistake, since this is a very valuable and potent drug, and Kaiser
260691 - policy is to help patients avoid mistakes of over medication from
260692 - double treatments.  Zan explained conflicting Pharmacy quality control
260693 - concern about returning medications to inventory once they leave the
260694 - premises, even though in this case it is only 20 minutes or so.  He
260695 - feels Kaiser should accept the Neupogen issued by mistake in order to
260696 - avoid the larger mistake of double medicating the patient.
260697 -
260698 -
260699 -
260701 -  ..
2608 -
2609 -
2610 - 1316
2611 -
261101 - Neupogen $2,000 Charge for 6 Treatments in Order to Get 1 Treatment
261102 -
261103 - Follow up ref SDS 70 5N9L, ref SDS 61 L86O.
261104 -
261105 - Millie arrived home from Kaiser with Neupogen from the Outpatient
261106 - Pharmacy.  She was very upset and explained having been required today
261107 - to buy six (6) treatments in order to get the one (1) treatment
261108 - prescribed by UCSF so that blood counts will increase to get
261109 - chemotherapy treatment with Carboplatin on Thursday.  Millie said the
261110 - cost was $2000, 4 times the cost paid on 080502, ref SDS 70 HF7K, and
261111 - which had, in turn, been 5 times the previous cost on 080405.
261112 - ref SDS 61 FZ56
261114 -  ..
261115 - Kaiser's invoice shows...
261116 -
261117 -            Kaiser Invoice
261119 -             ..
261120 -            Kaiser Permanente
261121 -            WCR Main Pharmacy
261122 -            1425 South Main St 1st Floor
261123 -            Walnut Creek, CA  94596
261124 -            925 295 4460
261126 -             ..
261127 -            Board A
261128 -            Claim Check #
261132 -             ..
261133 -            Patient...
261137 -             ..
261138 -            Date:  080609
261140 -             ..
261141 -            Medical Record...
261145 -             ..
261146 -            Your Durg Benefit Saved You:                    $ 62.36
261147 -            YTD Pharmacy Charges Applied to Troop/TDC
261148 -
261149 -                         Bal  2712.98                  Bal  4846.00
261151 -             ..
261152 -            Kaiser Permanente
261154 -             ..
261155 -            Rx# 512 08161 01036 A............. 2061.55    $ 1999 19
261156 -
261157 -              Neupogen 6 treatments 480 mg each
261158 -
261159 -                   [On 080628 Kaiser protocol requires 2 shots of 240
261160 -                   mg rather than 1 shot of 480 mg. ref SDS 84 Q74G
261162 -             ..
261163 -            Rx# 512 08161 01189 A.............    1.05         1.05
261164 -
261165 -              Self-injection needles
261167 -             ..
261168 -            Total Rx price............................... $ 2000.24
261169 -            Non-PIMS Rx Total
261170 -            Taxable OTC Total
261171 -        Non-taxable OTC Total
261172 -            Sales tax
261174 -             ..
261175 -            Total........................................ $ 2000.24
261177 -             ..
261178 -            All prescription sales are final.  Unopened
261179 -            over-the-counter items may be returned for Refund within 30
261180 -            days with the original receipt.
261182 -             ..
261183 -            Consult your pharmacist or physician with a list of
261184 -            medications your are currently taking if you have any
261185 -            questions about adverse drug reactions.
261187 -             ..
261188 -            Thank you for choosing Kaiser Permanente
261189 -            ID:  U923987      WCRI02   A
261190 -
261192 -  ..
261193 - Millie explained that she paid $2,000 for 6 Neupogen treatments to get
261194 - her 1 Neupgoen treatment ordered by the doctor at UCSF, ref SDS 0
261195 - YE67, because she was afraid UCSF would not approve her treatment for
261196 - cancer on Thursday without the 1 Neupogen treatment to increase blood
261197 - counts.  She has already missed 4 treatments the past 2 months.  This
261198 - would make the 4th consecutive cycle of not getting the prescribed
261199 - amount of chemotherapy, which creates a big risk that her disease will
261200 - begin to progress.
261202 -         ..
261203 -        [On 080619 stress and anxiety increase again when Kaiser calls
261204 -        and says the Imaging Department cannot use the new Power Port
261205 -        on 080718 being implanted 10 days earlier on 070708 to inject
261206 -        CT test contrast medium in order, ref SDS 78 ER5K; Kaiser
261207 -        insists on injuring Millie's arm with multiple needle punctures
261208 -        in order to resolve a labor dispute at Kaiser over which trade
261209 -        can use a Huber needle. ref SDS 78 OQ57
261211 -         ..
261212 -        [On 080627 primary care physician at Kaiser writing letter
261213 -        to resolve the problem. ref SDS 83 NM3M
261215 -  ..
261216 - Explained the call from Zan just a few mintues ago that the doctor
261217 - changed the prescription from home care to treatment in the Infusion
261218 - Clinic in order to avoid more mistakes, like what happened on
261219 - Saturday, 080607. ref SDS 77 Q67I  Zan had to cancel the order Millie
261220 - just received in order to enter the doctor's corrected order, and so
261221 - must return the Neupogen to the Outpatient Pharmacy in order to avoid
261222 - double prescriptions with the Oncology Pharmacy. ref SDS 0 K195
261224 -  ..
261225 - We drove back to Kaiser to return the Neupogen on the cancelled order
261226 - to avoid quality control problems Zan described of duplicate
261227 - prescriptions.
261228 -
261229 -
261231 -  ..
2613 -
2614 -
2615 - 1316
2616 -
261601 - Neupogen Returned to Kaiser Outpatient Pharmacy
261602 - Kaiser Outpatient Pharmacy Meeting Correct Neupogen Mistake
261603 -
261604 - Millie explained the mixup an hour ago with the order for Neupogen
261605 - going to wrong pharmacy, as explained in the doctor's telephone and
261606 - email messages earlier today, per above. ref SDS 0 837J   This led to
261607 - a mistake paying $2,000 for medication prescribed incorrectly from the
261608 - Outpatient Pharmacy per above, ref SDS 0 028F, and this conflicted
261609 - with the doctor ordering treatment in the Infusion Clinic, also,
261610 - above. ref SDS 0 IL6I
261612 -  ..
261613 - The clerk, Jessica, said Kaiser will refund payment to Millie on the
261614 - cancelled order for Neupogen today, per above, ref SDS 0 K195, similar
261615 - to the cancelled order to correct a prior mistake on a Neupogen
261616 - prescription that occurred 080418. ref SDS 66 EM6G  Jessica asked for
261617 - Millie's Kaiser membership card and her credit card.  Millie provided
261618 - these.
261620 -  ..
261621 - Jessica prepared documents for the refund to correct the mistake.
261622 - She asked for the invoice.
261624 -  ..
261625 - Millie submitted the invoice for $2,000.24 for 6 Neupogen treatments
261626 - and the syrenges; Jessica found the invoice on Kaiesr's computer, per
261627 - above. ref SDS 0 255K
261629 -  ..
261630 - Jessica consulted with Mellanie, the Pharmacist.
261632 -  ..
261633 - Mellanie looked at Kaiser's computer and saw that Zan had cancelled
261634 - the order, and entered a new order for Millie to get Neupogen
261635 - treatments in the Infusion Clinic.  Mellanie requested the unused
261636 - Neupogen treatments, per Zan's understanding that Kaiser policy
261637 - prohibits double medications that cause risks of complications, per
261638 - above. ref SDS 0 K195
261640 -  ..
261641 - Millie returned the Neupogen and needles received earlier today from
261642 - the Outpatient Pharmacy under Kaiser's invoice, per above. ref SDS 0
261643 - 255K
261645 -  ..
261646 - Mellanie took the Neupogen treatments from Millie, and prepared a note
261647 - to explain the transaction was cancelled by the Oncology Pharmacist,
261648 - per above. ref SDS 0 K195  She stored the Neupogen in a refrigerator
261649 - behind the counter.
261651 -  ..
261652 - Mellanie and Jessica checked the computer and confirmed that Zan in
261653 - the Oncology Pharmacy across the hall has scheduled Millie for 3
261654 - weekly sets of 2 Neupogen treatments in the Infusion Clinic beginning
261655 - on 080619, 080620, per Zan's call earlier today, above. ref SDS 0 016S
261657 -  ..
261658 - Mellanie asked for Millie's credit card to refund the $2,000.24
261659 - charged earlier by mistake. ref SDS 0 YE64  Millie handed over the
261660 - credit card used to pay for the earlier transaction. ref SDS 0 028F
261662 -  ..
261663 - Mellanie said there seems to be a mistake in the computer.  She
261664 - explained that since Zan in the Oncology Pharmacy cancelled the
261665 - Outpatient Pharmacy order 20 minutes earlier, the computer will not
261666 - accept a transaction for the Outpatient Pharmacy to cancel the order
261667 - again, which is necessary for the computer to process a refund for
261668 - overpayment.  Her training did not cover how to get the computer to
261669 - correct mistakes.
261671 -  ..
261672 - Mellanie commented that this whole thing seems very confusing.  Aligns
261673 - with the doctor's call this morning reporting a mistake ordering
261674 - Millie's treatment due to confusion using Kaiser's computer system,
261675 - ref SDS 0 837J, and discussion with Zan in the Oncology Pharmacy.
261676 - ref SDS 0 027G  The case study on 061024 indicates problems using
261677 - Kaiser's computer system. ref SDS 6 9W4O
261679 -             ..
261680 -            [On 080627 another computer mistake prevented scheduling
261681 -            the work because the computer went down while the schedule
261682 -            clerk explained complications that prevented following the
261683 -            doctor's order scheduling the work. ref SDS 83 RT73
261685 -             ..
261686 -            [On 080809 Donna reported Kaiser's schedule omits Millie's
261687 -            treatment on 080823. ref SDS 87 C24J
261689 -             ..
261690 -            [On 080822 Kaiser's schedule still omits Millie's treatment
261691 -            on 080823. ref SDS 88 GW73
261693 -             ..
261694 -            [On 080823 the next day, Hazel discovered the computer
261695 -            mysteriously changed the schedule received 080822, causing
261696 -            2 new problems scheduling Millie's treatments. ref SDS 89
261697 -            5T6N
261699 -  ..
261700 - Millie explained the Outpatient Pharmacy previously cancelled an order
261701 - on 080418 to correct a mistake due to confusion ordering Neupogen.
261702 - ref SDS 66 EM6G
261704 -  ..
261705 - Mellanie studied the computer for several mintues, and then indicated
261706 - there might be a way to correct the mistake.  She tried several steps
261707 - with the computer, checking other parts of the system.  Eventually,
261708 - Mellanie gave up and said that if Millie had arrived at the Pharmacy
261709 - 20 minutes earlier, she could have entered a cancellation order in the
261710 - computer and the computer would have processed the refund to correct
261711 - the mistake.  But, since Zan already cancelled the erroneous order the
261712 - computer prevents correcting the first mistake.
261714 -  ..
261715 - Problems using computers for case management were reported on 021214.
261716 - ref SDS 1 X24K
261718 -             ..
261719 -            [On 080627 primary care physician at Kaiser writing letter
261720 -            to resolve the problem. ref SDS 83 NM3M
261722 -             ..
261723 -            [On 080707 Kaiser computer in Surgery Department did not
261724 -            notify Coagulation Control Clinic to pause Coumadin
261725 -            treatments required for surgery. ref SDS 85 JP7W
261727 -  ..
261728 - Mellanie asked an assistant to call Zan in the Oncology Pharmacy to
261729 - investigate a solution.   While this call was pending, Mellanie
261730 - assisted other customers.  After 10 minutes, it was getting close to
261731 - 1700, when people start leaving work to go home for the day.  Mellanie
261732 - suggested walking over to the Oncology Department to see if they can
261733 - get Zan's attention before he goes home.
261735 -  ..
261736 - Went to the Oncology Department.  A customer representative was
261737 - closing the counter, but was able to place a call to the Oncology
261738 - Pharmacy.
261740 -  ..
261741 - Talked to Zan's assistant by telephone.
261743 -  ..
261744 - She checked the computer and noted that the Outpatient Pharmacy cannot
261745 - retain $2,000 payment for medication on an order cancelled to correct
261746 - a computer mistake, per above. ref SDS 0 K195  Since Zan has scheduled
261747 - Millie for Neupogen treatments in the Infusion Clinic ordered by the
261748 - doctor, ref SDS 0 IL6I, Kaiser cannot double bill the patient.
261750 -  ..
261751 - Went back to the Outpatient Pharmacy.  Talked to Mellanie again.
261753 -  ..
261754 - Mellanie was upset that the Pharmacy will get unfairly cited in an
261755 - audit because computer error caused payments received of $2,000 out of
261756 - balance with an order that was cancelled to conform with Kaiser
261757 - quality control requirements for patient standard of care, per above.
261758 - ref SDS 0 IS47  She feels the doctor should assist to refund
261759 - overpayment so that Pharmacy accounts are in balance with
261760 - prescriptions by the doctor.
261762 -  ..
261763 - As noted, problems using computers for health care case management are
261764 - shown in a case study on 061024. ref SDS 6 QJ4G
261766 -             ..
261767 -            [On 080619 Millie reported computer mix up at Kaiser to
261768 -            medical team that caused inventory conflict with Kaiser
261769 -            quality care requirements for Neupogen treatments
261770 -            prescribed by UCSF. ref SDS 79 YU9T
261772 -             ..
261773 -            [On 080625 Millie submits agenda for meetings with medical
261774 -            team that includes resolving computer problem setting up
261775 -            Neupogen treatments. ref SDS 81 MV9K
261777 -             ..
261778 -            [On 080627 primary care physician explains worry and
261779 -            concern about clinical trial programs being audited by
261780 -            state agency for compliance with protocol requirements; can
261781 -            write letter explaining deviation required for patient
261782 -            health. ref SDS 83 WX6I
261784 -             ..
261785 -            [On 080627 another Kaiser computer problem scheduled
261786 -            treatments incorrectly; corrected by the doctor writing a
261787 -            letter to Oncology Pharmacy. ref SDS 83 XK5K
261789 -             ..
261790 -            [On 080627 primary care physician at Kaiser writing letter
261791 -            to explain Neupogen treatment protocol required for patient
261792 -            health. ref SDS 83 BT5J
261794 -             ..
261795 -            [On 080628 Kaiser protocol requires Millie get 2 injections
261796 -            of 240 mcg for Neupogen prescribed by UCSF indicates
261797 -            confusion and error by Outpatient Pharmacy providing
261798 -            treatment with a single injection of 480 mcg. ref SDS 84
261799 -            Q74G
261801 -             ..
261802 -            [On 080707 Kaiser computer in Surgery Department did not
261803 -            notify Coagulation Control Clinic to pause Coumadin
261804 -            treatments required for surgery. ref SDS 85 JP7W
261806 -             ..
261807 -            [On 081105 Kaiser computer in Nuclear Medicine scheduled
261808 -            Millie for Muga test on 081106 1030, when this was
261809 -            impossible because she is out of town. ref SDS 90 6H6F
261811 -             ..
261812 -            [On 081105 Kaiser computer in Nuclear Medicine made another
261813 -            mistake, schedule for Muga test changed for 3rd time.
261814 -            ref SDS 91 N54H
261816 -             ..
261817 -            [On 081106 Kaiser computer problem caused erroneous
261818 -            schedule core biopsy to evaluate for expanding cancer
261819 -            treatment options. ref SDS 92 PQ9Y
261821 -             ..
261822 -            [On 081106 computer problem managing patient history on
261823 -            blood tests for Creatinine required Millie's brain MRI at
261824 -            Kaiser in Antioch. ref SDS 93 FR5H
261826 -             ..
261827 -            [On 081205 doctor orders patient cannot self-medicate with
261828 -            Neupogen. ref SDS 94 JE5I
261830 -             ..
261831 -            [On 081229 computer problem recurring in CT Department
261832 -            staff not aware of doctor's referral to perform test using
261833 -            Power Port for injecting contrast medium, and not aware
261834 -            accessing Power Port scheduled in Infusion Clinic, and
261835 -            requires coordinating support from IS. ref SDS 95 5G3I
261836 -
261837 -
261838 -
261839 -
261840 -
261841 -
261842 -
261843 -
261844 -
261845 -
2619 -