Abstract:Purpose
Anticoagulant drugs are among the most common medications that cause adverse drug events (ADEs) in hospitalized patients. We performed a five-year retrospective study at Brigham and Women’s Hospital to determine clinical characteristics, types, root causes, and outcomes of anticoagulant-associated adverse drug events (ADEs).
Methods
We reviewed all inpatient anticoagulant-associated ADEs, including adverse drug reactions (ADRs) and medication errors, reported at Brigham and Women’s Hospital through t… Show more
“…[14] This study aimed to investigate the effect of computer recording of medical orders on the number of adverse medication events and errors, and was a two-group study with a control group and a higher number of subjects compared to the present study. In another study, the researchers reported positive results in investigation of the effect of interactional education on reduction of medication errors of high-risk drugs in ICUs.…”
Background:Medication errors and adverse drug events of high alert medication are one of the major problems in therapeutic system. The purpose of the present study was to investigate ύthe effect of clinical supervision model on high alert medication safety in intensive care units nurses.Materials and Methods:This was a quasi-experimental study conducted on 32 nurses of intensive care units. The researcher observed the administration of high alert drugs including heparin, warfarin, norepinephrine, dobutamine, and dopamine by nurses and recorded the scores of the work in preventing medication errors, the work in preventing adverse drug events, and medication safety. Then, the researcher performed clinical supervision model and during performance of the model, the researcher reassessed the score of the work in preventing medication errors, The work in preventing adverse drug events and medication safety. Tool of data collection was action plan of high alert medication safety checklists (heparin, warfarin, norepinephrine, dobutamine, and dopamine checklists).Results:The result of the statistical trials showed that before and after applying the clinical supervision model, there was a statistically significant difference between the average scores of medication safety of heparin (15.7 vs 18.73), warfarin (11.08 vs 15.67), norepinephrine (14.60 vs 19.72), dobutamine (13.80 vs 19.30), and dopamine (14.25 vs 19.47).Conclusions:Based on the results of this study, it seems that administration of clinical supervision model in intensive care units can lead to improving the status of safety of high alert medication.
“…[14] This study aimed to investigate the effect of computer recording of medical orders on the number of adverse medication events and errors, and was a two-group study with a control group and a higher number of subjects compared to the present study. In another study, the researchers reported positive results in investigation of the effect of interactional education on reduction of medication errors of high-risk drugs in ICUs.…”
Background:Medication errors and adverse drug events of high alert medication are one of the major problems in therapeutic system. The purpose of the present study was to investigate ύthe effect of clinical supervision model on high alert medication safety in intensive care units nurses.Materials and Methods:This was a quasi-experimental study conducted on 32 nurses of intensive care units. The researcher observed the administration of high alert drugs including heparin, warfarin, norepinephrine, dobutamine, and dopamine by nurses and recorded the scores of the work in preventing medication errors, the work in preventing adverse drug events, and medication safety. Then, the researcher performed clinical supervision model and during performance of the model, the researcher reassessed the score of the work in preventing medication errors, The work in preventing adverse drug events and medication safety. Tool of data collection was action plan of high alert medication safety checklists (heparin, warfarin, norepinephrine, dobutamine, and dopamine checklists).Results:The result of the statistical trials showed that before and after applying the clinical supervision model, there was a statistically significant difference between the average scores of medication safety of heparin (15.7 vs 18.73), warfarin (11.08 vs 15.67), norepinephrine (14.60 vs 19.72), dobutamine (13.80 vs 19.30), and dopamine (14.25 vs 19.47).Conclusions:Based on the results of this study, it seems that administration of clinical supervision model in intensive care units can lead to improving the status of safety of high alert medication.
“…The mainstay of the treatment is thromboprophylaxis, usually using Vitamin K antagonists. However, there is no consensus regarding the patient screening criteria and treatment duration because anticoagulant drugs are among the most common medications that cause adverse events 39) . Therefore, in order to select which patients should receive thromboprophylaxis, new biomarkers are needed that would make it possible to identify patients with a pro-thrombotic state and at high risk of clinical events 40) .…”
Aim: Antiphospholipid syndrome (APS) is characterized by recurrent thrombosis and/or gestational morbidity in patients with antiphospholipid autoantibodies (aPL). Over recent years, IgA anti-beta2-glycoprotein I (B2GPI) antibodies (IgA aB2GPI) have reached similar clinical relevance as IgG or IgM isotypes. We recently described the presence of immune complexes of IgA bounded to B2GPI (B2A-CIC) in the blood of patients with antecedents of APS symptomalology. However, B2A-CIC's clinical associations with thrombotic events (TEV) have not been described yet.Methods: A total of 145 individuals who were isolate positive for IgA aB2GPI were studied: 50 controls without any APS antecedent, 22 patients with recent TEV (Group-1), and 73 patients with antecedents of old TEV (Group-2).Results: Mean B2A-CIC levels and prevalence in Group-1 were 29.6 ± 4.1 AU and 81.8%, respectively, and were significantly higher than those of Group-2 and controls (p < 0.001). In a multivariable analysis, positivity of B2A-CIC was an independent variable for acute thrombosis with a 22.7 odd ratio (confidence interval 5.1 –101.6, 95%, p < 0.001). Levels of B2A-CIC dropped significantly two months after the TEV. B2A-CIC positive patients had lower platelet levels than B2A-CIC-negative patients (p < 0.001) and more prevalence of thrombocytopenia (p < 0.019). Group-1 had no significant differences in C3 and C4 levels compared with other groups.Conclusion: B2A-CIC is strongly associated with acute TEV. Patients who did not develop thrombosis and were B2A-CIC positive had lower platelet levels, which suggest a hypercoagulable state. This mechanism is unrelated to complement-fixing aPL. B2A-CIC could potentially select IgA aB2GPI-positive patients at risk of developing a thrombotic event.
“…Because the authors performed a root cause analysis, they were able to look at the reason why the errors occurred. The most common cause was transcription errors (48%), followed by memory lapses (16.1%) and infusion or parenteral administration problems (8.7%); this is despite the presence of a Medical Information System that integrates online medical records, computerised provider order entries and electronic medication administration records 13. Aside from articles about medication errors in hospital, Fanikos et al focused on adverse drug events and medication errors in hospitalised patients with cardiac issues 14.…”
Aim
Anticoagulant therapy is considered a high-risk medication strategy with a narrow therapeutic window and the need for close monitoring, particularly with vitamin K antagonists. The nature of the drugs as well as the way they are administered make it more likely mistakes will occur. At all stages of care, ambulatory as well as in hospital, avoidable medication errors are seen. This review was performed to elucidate the number and nature of medication errors with anticoagulants and to look at possibilities for improving anticoagulant therapy.
Methods
A literature review was performed in PubMed, Medline and other sources looking after articles concerning medication errors in which anticoagulants are separately mentioned. From these articles, the risk factors were identified.
Results
A total of 17 papers were selected where medication errors with anticoagulant drugs were described. It became clear that medication errors occur from the doctor prescribing the medication, to the compliance of the patient with taking the treatment, and all steps in between. Communication between caregivers and between caregivers and patients seems to be an important factor.
Conclusions
This review shows that improvement is possible throughout the whole anticoagulant medication chain, starting with instructions for those prescribing drugs to education for patients.
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