Medication Errors in Acute Cardiovascular and Stroke Patients

Michaels, Andrew D.; Spinler, Sarah A.; Leeper, Barbara; Ohman, E. Magnus; Alexander, Karen P.; Newby, L. Kristin; Ay, Hakan; Gibler, W. Brian

doi:10.1161/cir.0b013e3181d4b43e

Cited by 76 publications

(37 citation statements)

References 141 publications

(119 reference statements)

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“…[1][2][3][4][5] Complex surgical procedures and patients with significant comorbidities often require therapeutic interventions with infrequently used medications utilized under dynamic conditions, all contributing to higher medication error rates when compared with cases with lower surgical complexity. 6,7 The inexperience of trainees in the specialty may also lead to a higher frequency of medication errors in teaching programs, yet there are few data to support this claim. 8 Two prospective studies 1,9 and one retrospective study 4 have reported human factors contributing to medication errors/pre-errors during the conduct of anesthesia.…”

Section: Introductionmentioning

confidence: 99%

Influences observed on incidence and reporting of medication errors in anesthesia

Cooper

DiGiovanni

Schultz

et al. 2012

Can J Anesth/J Can Anesth

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Background Medication errors are a common occurrence during the conduct of anesthesia (one in 113-450 patients). Several factors contribute to medication errors in anesthesia, including experience of the anesthesia provider, severity of comorbidities, and type of procedure. The inexperience of anesthesia providers-in-training also leads to increased error rates. This prospective observational study repeats and extends previous work by Webster et al. and Llewellyn et al. examining the role of comorbidities, type of case, and level of provider experience on the incidence of medication errors. Methods After Institutional Review Board review and exemption from informed consent, medication error reporting forms were attached to every anesthetic record during a six-month period. All providers were asked to return the forms for every anesthetic, on a strictly voluntary and anonymous basis, and to record the occurrence of medication errors. If providers indicated that a medication error had occurred, additional details about the event were obtained anonymously. Results There were 8,777 (83%) responses obtained in a review of 10,574 case forms. A medication error was reported in 35 forms, with an additional 17 forms indicating a medication pre-error or near miss, resulting in 52 (0.49%) errors/pre-errors or a reported incidence of 1:203 anesthetics. Most case types were observed to have a statistically significant increase in reported medication errors. Reported errors by type of anesthesia provider were categorized into anesthesia provider-in-training group and the experienced provider group. The anesthesia providerin-training group reported a twofold increase in the rate of errors, with the most frequently reported errors being incorrect dose and substitution.

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Section: Introductionmentioning

confidence: 99%

Influences observed on incidence and reporting of medication errors in anesthesia

Cooper

DiGiovanni

Schultz

et al. 2012

Can J Anesth/J Can Anesth

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“…[9,10] Our study results were in accord with other trials in that stated weights (by the patient or caregiver) were more accurate than weights estimated by ED staff. [1][2][3][4][5][6][7] Our data also reveal some interesting detail about the factors associated with weight estimation inaccuracies. Our data show that heavier, taller, or English speaking patients are more likely to be under-dosed, and that patients with a lower actual body weight and older patients are more likely to receive an over-dose.…”

Section: )mentioning

confidence: 74%

“…[1] Accurate patient weights are a vital piece of patient-specific information needed in the emergency department (ED) to assure appropriate dosing for many medications. [2] However, in daily practice, where clinicians have to obtain body weight urgently, logistical and workflow issues do not always make this practical.…”

Section: Introductionmentioning

confidence: 99%

“…Weight estimations by ED staff, however, are often inaccurate and these errors are more pronounced in patients who are underweight or obese. [1][2][3][4][5][6][7] Because many medications are dosed based on actual (and not ideal) body weight, overestimation and underestimation of body weight constitute an important source of medication errors that result in adverse medication events and ineffectiveness, respectively.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Enoxaparin dosing errors in the emergency department

Jellinek-Cohen

Husk

2018

World Journal of Emergency Medicine

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BACKGROUND:The study aimed to determine the frequency of enoxaparin dosing errors for patients who had a measured emergency department (ED) weight compared to those who did not have a measured ED weight, and to determine if demographic variables (e.g., weight, height, age, Englishspeaking, race) impact the likelihood of receiving an inappropriate dose.METHODS: This is a retrospective, electronic chart review of patients who received a dose of enoxaparin in the ED between January 1, 2008 and July 1, 2013. We identifi ed all patients >18 years who received a dose of enoxaparin while in the ED, were admitted, and had at least one inpatient weight within the fi rst four days of hospitalization. Patients were excluded if they received enoxaparin for prophylaxis or a dose of more than 1.25 mg/kg. RESULTS:A total of 1,944 patients were included. Patients were more likely to experience an error if they did not have a measured ED weight. Over-doses of >10 mg were more likely to occur in patients without a measured ED weight. Patients with no documented ED weight or with a staffestimated ED weight were more likely to experience a dosing error than those with a patient-stated weight. Patients were more likely to experience an error if their fi rst inpatient weight was more than 96 kg, they were more than 175-cm tall, or were English speaking.CONCLUSION: Dosing errors are more likely to occur when patients are not weighed in the ED. Modifications to current workflows to incorporate weighing those patients who receive weightdosed medications may be warranted.

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“…2011;86(12):1161-1164 ACS = acute coronary syndrome; CKD = chronic kidney disease; CPOE = computerized physician order entry; CrCl = creatinine clearance; GP = glycoprotein; IOM = Institute of Medicine; TIMI = Thrombolysis in Myocardial Infarction weight heparin, is an anticoagulant that is renally cleared and is not recommended in patients with severe CKD. 6,8,9 Similarly, eptifibatide, a small-molecule glycoprotein (GP) IIb/IIIa inhibitor, is renally cleared and is contraindicated in patients with severe CKD because of the high risk of bleeding complications. 10 Alternative medications that are not renally cleared are available, including unfractionated heparin and abciximab.…”

Section: Resultsmentioning

confidence: 99%