Sunday, April 10, 2011

Terms of reference, terms of schmeference !

After years of waiting, dexmedetomidine is now available in Canada. I have been in the business long enough to know that there are no panaceas and the best thing since sliced bread is still sliced bread, however we felt dexmedetomidine might be useful in the MRI suite where we anaesthetize obese claustrophobic patients and for other uses. Consequently we placed a request into our pharmacy committee for the addition of dex.

Anaesthetic drugs which cost $40 are low priority in comparison with other more important drugs like the latest cancer drug which will increase life expectancy by one month in 10% of patients, so I wasn't expecting much. A couple of days ago, I got this from our new P and T committee.

Here is an update on the status of your request:

“Dexmedetomidine for Procedural Sedation” was on the agenda for the late March provincial P&T meeting.
Because the March meeting was the first time the group had met, more than half of the five hour meeting was spent reviewing the Committee’s structure and Terms of Reference.
Consequently, the committee ran out of time to discuss a few of the agenda items and “Dexmedetomidine for Procedural Sedation” was one of those items.
“Dexmedetomidine for Procedural Sedation” will remain on the agenda for discussion at the next meeting.
The plans are that the committee will meet every two months initially.

That is right. This committee spent 2.5 hours reviewing its structure and terms of reference. About 2 years ago all the health regions in the province were amalgamated into one single region. Up until recently we didn't even have a P and T committee which was the reason given for not approving drugs. Now we have one and it has finally met and spent one half of its meeting time looking at its navel. P and T committees aren't a new thing, every region had one, before that every hospital had one. It is pretty certain that every member of the new super-committee had been on a P and T committee.

What is the name of this blog again?

This gave me an unpleasant flashback to the last millennium and the first reorganization of health care I was involved in. At that time our newly formed region decided they were going to develop and region-wide chronic pain program. The timing was auspicious; there were people actually interested in doing this and with downsizing and closing of hospital beds there was actually ample physical space in which to have one. Moreover somebody had actually spent two years under the previous administration drawing up a plan complete with a budget that we could actually have rolled out within a few months.

Instead of just doing this, we did the logical thing and formed a committee. Once a week from 1600 to 1800 we would meet to discuss how we were going to deliver chronic pain management to the community. But first we had to develop a mission statement. This took 2 or 3 meetings. Then we had to define what exactly chronic pain was. This took 2 or more meetings (I'm not making this up). We had two all day retreats on weekends during which the stakeholders were consulted and more meetings. After a while I figured that the fix was in and stopped going. I was right of course. While we were busily filling flip charts, the entrepreneurial physiatrist who was chairing the committee had been negotiating directly with the government and guess who got all the money? 15 years later I more or less do things the way I did 15 years ago. I should get over this but I won't.

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