Medication Errors in Patients With Severe Chronic Kidney Disease and Acute Coronary Syndrome: The Impact of Computer-Assisted Decision Support

Milani, Richard V.; Oleck, Sylvia; Lavie, Carl J.

doi:10.4065/mcp.2011.0290

Cited by 21 publications

(58 citation statements)

References 24 publications

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“…Data collection period ranged from 1 day to 5 years. The most frequent period was 2 years in three studies …”

Section: Resultsmentioning

confidence: 96%

“…Seven studies, 80%, did not validate the reported errors . One study did partial validation of the reported errors, when one author independently randomly checked reported data Another study validated all reported errors through a panel of senior doctors…”

Section: Resultsmentioning

confidence: 99%

“…More than half of the studies, 55% (5/9), had been carried out prospectively and 45% (4/9) retrospectively . Data collection period ranged from 1 day to 5 years.…”

Section: Resultsmentioning

confidence: 99%

“…Pharmacists were data collectors in two studies, whereas in one study, the data collectors were research assistants who were not healthcare professionals . Most studies (7/9) used the prescription review method . The medical record review method was used in two studies, as was a pharmacist‐intercepted errors database .…”

Section: Resultsmentioning

confidence: 99%

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A systematic review of the prevalence and incidence of prescribing errors with high‐risk medicines in hospitals

2016

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SUMMARYWhat is known: Prescribing errors are the most common type of error in the medication use process. However, there is a paucity of literature regarding the prevalence or incidence of prescribing errors in high-risk medicines (HRMs). HRMs bear a heightened risk of causing significant patient harm when they are used in error.Objective: The aim of this research was to systematically investigate the literature regarding the prevalence and incidence of prescribing errors in HRMs in inpatient settings. Methods: A search strategy was developed based on four categories of keywords: prescribing errors, HRMs, hospital inpatients, and prevalence or incidence. All keywords were searched for in Medline, Embase, Cochrane and the International Pharmaceutical Abstracts. The search was limited to English quantitative studies that reported the incidence or prevalence of prescribing errors by medical prescribers, whether they were seniors or juniors, since 1985. Results: Of the 3507 records identified, nine studies met the review criteria. The most frequent denominator in the included studies was medication orders, in eight studies, ranged from 0Á24 to 89Á6 errors per 100 orders of HRMs. Two studies reported 107 and 218 errors per 100 admissions prescribed HRMs, and one study reported 27Á2 errors per 100 prescriptions with a HRM. The incidence of prescribing errors could not be calculated. What is new and conclusion: The prevalence of prescribing errors in HRMs in the inpatient setting has a very wide range that reflects the different data collection methods used within the included studies. Future studies in prescribing errors should use standardized approaches to enable comparison. WHAT IS KNOWN AND OBJECTIVEMedications are a crucial part in the process of seeking health, when they are used wisely. However, medication errors, which are preventable by the definition of the National Coordinating Council for Medication Error Reporting and Prevention (NCC MERP) organization, 1 are one of the obstacles that face healthcare providers when keeping patients safe, particularly inpatients. Inpatient settings are vulnerable areas for medication errors, 2 which can increase the cost of patient care by increasing the length of stay in hospital, increasing pharmacy and laboratory costs, and doubling the patient mortality rate. 3Prescribing errors are the most frequent subtype of medication errors, occurring in 7% of medication orders, 50% of hospital admissions and 2% of inpatients. 4 The percentage of prescribing errors range from 29% to 56% of medication errors in adults, 5,6 and these figures have been found to be higher in children, with a range of 68-75%. 7,8

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“…Data collection period ranged from 1 day to 5 years. The most frequent period was 2 years in three studies …”

Section: Resultsmentioning

confidence: 96%

Section: Resultsmentioning

confidence: 99%

“…More than half of the studies, 55% (5/9), had been carried out prospectively and 45% (4/9) retrospectively . Data collection period ranged from 1 day to 5 years.…”

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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A systematic review of the prevalence and incidence of prescribing errors with high‐risk medicines in hospitals

2016

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“…However, there are few studies on the extent of contraindicated medication use in clinical practice. 2-5 …”

Section: Introductionmentioning

confidence: 99%

Use of Contraindicated Antiplatelet Medications in the Setting of Percutaneous Coronary Intervention

Barnes

Stanislawski²,

Liu³

et al. 2016

Circ: Cardiovascular Quality and Outcomes

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Background Several antiplatelet medications used during and after percutaneous coronary intervention (PCI) are contraindicated for specific patient groups. A broad assessment of contraindicated medication use and associated clinical outcomes is not well described. Methods and Results Using national VA CART Program data for all PCI between 2007-2013, we evaluated patients with contraindications to commonly used antiplatelet medications during and after PCI, defined in accordance with package inserts. Adjusted association between contraindicated medication use and outcomes of periprocedural bleeding and 30-day mortality were assessed using Cox proportional hazards with inverse probability weighting. Among 64,294 patients undergoing PCI, 11,315(17.6%) had a contraindication to a common antiplatelet medication and 737 (6.5%) of these patients received a contraindicated medication. In unadjusted analyses, any contraindicated medication use was associated with both increased bleeding and 30-day mortality. In adjusted models, contraindicated abciximab use in patients with thrombocytopenia (HR 2.23, 95% CI 1.58-3.16) and in patients with a prior stroke (HR 1.93, 95% CI 1.37-2.71) remained significantly associated with increased bleeding. Contraindicated abciximab use was not significantly associated with 30-day mortality in adjusted models. Use of eptifibatide in dialysis patients was not significantly associated with an increased risk of bleeding or mortality. Conclusions In this national cohort, about 18% of patients undergoing PCI had contraindications to common antiplatelet medications. Approximately 6% of those patients received a contraindicated medication with attendant bleeding risk, although this did not translate into significantly higher risk of 30-day mortality. Continued efforts to reduce contraindicated medication use may help avoid periprocedural complications.

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Potentially Inappropriately Prescribed Medications Among Medicare Medication Therapy Management Eligible Patients with Chronic Kidney Disease: an Observational Analysis

et al. 2021

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Background Potentially inappropriately prescribed medications (PIPMs) among patients with chronic kidney disease (CKD) may vary among clinical settings. Rates of PIPM are unknown among Medicare-enrolled Medication Therapy Management (MTM) eligible patients. Objectives Determine prevalence of PIPM among patients with CKD and evaluate characteristics of patients and providers associated with PIPM. Design An observational cross-sectional investigation of a Medicare insurance plan for the year 2018. Patients Medicare-enrolled MTM eligible patients with stage 3–5 CKD. Main Measures PIPM was identified utilizing a tertiary database. Logistic regression assessed relationship between patient characteristics and PIPM. Key Results Investigation included 3624 CKD patients: 2856 (79%), 548 (15%), and 220 (6%) patients with stage 3, 4, and 5 CKD, respectively. Among patients with stage 3, stage 4, and stage 5 CKD, 618, 430, and 151 were with at least one PIPM, respectively. Logistic regression revealed patients with stage 4 or 5 CKD had 7–14 times the odds of having a PIPM in comparison to patients with stage 3 disease (p < 0.001). Regression also found PIPM was associated with increasing number of years qualified for MTM (odds ratio (OR) 1.46–1.74, p ≤ 0.005), female gender (OR 1.25, p = 0.008), and increasing polypharmacy (OR 1.30–1.57, p ≤ 0.01). Approximately 14% of all medications (2879/21093) were considered PIPM. Majority of PIPMs (62%) were prescribed by physician primary care providers (PCPs). Medications with the greatest percentage of PIPM were spironolactone, canagliflozin, sitagliptin, levetiracetam, alendronate, pregabalin, pravastatin, fenofibrate, metformin, gabapentin, famotidine, celecoxib, naproxen, meloxicam, rosuvastatin, diclofenac, and ibuprofen. Conclusion Over one-third of Medicare MTM eligible patients with CKD presented with at least one PIPM. Worsening renal function, length of MTM eligibility, female gender, and polypharmacy were associated with having PIPM. Majority of PIPMs were prescribed by PCPs. Clinical decision support tools may be considered to potentially reduce PIPM among Medicare MTM–enrolled patients with CKD.

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Medication Errors in Patients With Severe Chronic Kidney Disease and Acute Coronary Syndrome: The Impact of Computer-Assisted Decision Support

Cited by 21 publications

References 24 publications

A systematic review of the prevalence and incidence of prescribing errors with high‐risk medicines in hospitals

A systematic review of the prevalence and incidence of prescribing errors with high‐risk medicines in hospitals

Use of Contraindicated Antiplatelet Medications in the Setting of Percutaneous Coronary Intervention

Potentially Inappropriately Prescribed Medications Among Medicare Medication Therapy Management Eligible Patients with Chronic Kidney Disease: an Observational Analysis

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