Too frequent low-dose methotrexate prescriptions: multicentre quality control and quality assurance with pre- and post-analysis

Karlen, Sascha; Oertle, Marc; Weiler, Stefan; Schneemann, Markus; Eschmann, Emmanuel; Kullak-Ublick, Gerd-Achim; Blaser, J

doi:10.4414/smw.2015.14218

Cited by 2 publications

(2 citation statements)

References 14 publications

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“…Kaiser Permanente is community‐based, our population is similar to other insured populations, and our findings for administration errors likely are generalizable. However, our setting may be less prone to medication errors stemming from the prescriber or the pharmacist because computerized order entry enables the pharmacy department to use best practices in structuring the computer interface and to provide standardized sigs that default to weekly administration schedules . In addition, the pharmacy can easily interact with the prescriber when an error is detected.…”

Section: Discussionmentioning

confidence: 99%

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Development of an algorithm to detect methotrexate wrong frequency error using computerized health care data

Herrinton

Woodworth

Eworuke

et al. 2019

Pharmacoepidemiology and Drug

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Purpose We validated an algorithm to detect frequency errors in computerized healthcare data and estimated the incidence of these errors in an integrated healthcare system. Methods We applied Sentinel System analytic tools on the electronic health records of Kaiser Permanente, Northern California, January 1, 2010, through May 30, 2015,to identify rheumatoid arthritis (RA) patients with new use of methotrexate (365‐day baseline period). We identified potential methotrexate frequency errors using ICD‐9 code 995.20 (adverse drug event), Current Procedural Terminology (CPT) code 96409 for injection of leucovorin and prescription refill patterns. We performed chart review to confirm the frequency errors, assessed performance for detecting frequency errors, and estimated the incidence of chart‐confirmed errors. Results The study included 24,529 methotrexate dispensings among 3,668 RA patients. Among these, 722 (3%) had one dispensing and 23,807 (97.1%) had ≥2 dispensings during 1‐year follow‐up period. We flagged 653 (2.7%) with a potential medication error (46 with one dispensing and 607 with ≥2 dispensings). We sampled 94 for chart review, and confirmed three methotrexate errors. All three confirmed frequency errors involved a first methotrexate dispensing followed by injected rescue therapy, leucovorin, (positive predictive value, 60%; 95% confidence interval [CI], 15‐95%). No potential errors were found among patients with ≥2 dispensings. We estimated the frequency error incidence among one methotrexate dispensing to be 0.4% (95%CI, 0.1% to 1.2%). Conclusion Rescue therapy is a specific indicator of methotrexate overdose among first methotrexate dispensings. This method is generalizable to other medications with serious adverse events treated with antidotes.

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Section: Discussionmentioning

confidence: 99%

“…because computerized order entry enables the pharmacy department to use best practices in structuring the computer interface and to provide standardized sigs that default to weekly administration schedules. 23 In addition, the pharmacy can easily interact with the prescriber when an error is detected.…”

Section: Discussionmentioning

confidence: 99%