Drug Shortage–Associated Increase in Catheter-Related Blood Stream Infection in Children

Ralls, Matthew W.; Blackwood, R. Alexander; Arnold, Meghan A.; Partipilo, M. Luisa; Dimond, James L.; Teitelbaum, Daniel H.

doi:10.1542/peds.2011-3894

Cited by 35 publications

(35 citation statements)

References 23 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Trials assessing the use of ethanol lock therapy for the prevention or reduction of CLABSI have shown a decreased rate with tolerable side effects and an increase in catheter survival time 78 – 82 . Blackwood et al 83 studied 15 patients in whom CVC infections failed standard intravenous antimicrobial treatment; 13 were successfully treated with ethanol lock therapy in treating 21 organisms, including 12 bacteria and 9 fungi.…”

Section: Prevention Strategies—ethanol Lock Therapymentioning

confidence: 99%

Central Venous Access in the Pediatric Population With Emphasis on Complications and Prevention Strategies

2016

View full text Add to dashboard Cite

Central venous catheters are often necessary in the pediatric population. Access may be challenging, and each vessel presents its own unique set of risks and complications. Central venous catheterization is useful for hemodynamic monitoring, rapid fluid infusion, and administration of hyperosmolar medications, including vasopressors, antibiotics, chemotherapy, and parenteral nutrition. Recent advances have improved the catheters used as well as techniques for insertion. A serious complication of central access is infection, which is associated with morbidity, mortality, and significant financial costs. Reduction of catheter-related bloodstream infections is realized with use of ethanol locks, single lumens when appropriate, and prudent adherence to insertion and maintenance bundles. Ultrasound guidance used for central venous catheter placement improves accuracy of placement, reducing time and unsuccessful insertion and complication rates. Patients with central venous catheters are best served by multidisciplinary team involvement.

show abstract

Section: Prevention Strategies—ethanol Lock Therapymentioning

confidence: 99%

Central Venous Access in the Pediatric Population With Emphasis on Complications and Prevention Strategies

2016

View full text Add to dashboard Cite

show abstract

“…In some cases, alternate medications may not exist and may lead to poor patient outcomes. 1,5,6 Beyond direct patient harm, shortages may also have an effect on the drug budget of the institution. Furthermore, clinicians may need to spend time away from patient care duties, procuring medication and ensuring proper education regarding alternate agents.…”

Section: What This Study Addsmentioning

confidence: 99%

Effects on Patient Care Caused by Drug Shortages: A Survey

McLaughlin¹,

Kotis²,

Thomson³

et al. 2013

JMCP

100

106

View full text Add to dashboard Cite

BACKGROUND: Drug shortages pose a serious challenge for health care institutions, often interfering with patient care. A common practice during a drug shortage is to select an alternate therapeutic; however, these agents often present challenges and may create safety concerns. Patient harms including adverse events and medication errors may occur. Patients may also file complaints because of drug shortages. OBJECTIVE: To measure the effect of drug shortages on patient outcomes, clinical pharmacy operations, patient complaints, and institutional cost.METHODS: An e-mail link to an online survey was sent to pharmacy director members in the MedAssets Pharmacy Group Purchasing Organization. Data were collected within a 3-week period from October 2-23, 2012. The survey focused on 6 different domains: demographics, adverse events, medication errors, patient outcomes, patient complaints, and institutional cost. RESULTS:The survey was sent to 1,516 directors of pharmacy. There were 193 respondents (response rate 13%) who participated in the survey. Approximately 40% of respondents reported between 1 and 5 adverse events probably or possibly associated with drug shortages at their institution. The majority of respondents reported between 1 and 10 medication errors. The most common types of medication errors reported were omission (n = 86, 55.5%), wrong dose dispensed/administered (n = 85, 54.8%), and wrong drug dispensed/administered (n = 54, 34.8%). The most common outcomes reported by respondents were alternative medication used (n=146, 85.3%), delay of therapy (n = 121, 70.8%), and increased patient monitoring necessary (n = 84, 49.1%). Patient complaints were reported by 38% of respondents. The majority of respondents reported an estimated quarterly institutional cost from shortages of less than $100,000, and approximately one quarter of respondents reported adding at least 1 full-time equivalent to manage drug shortages. The majority of participant comments mentioned the increasing institutional costs attributed to drug shortages.CONCLUSIONS: Medication errors and adverse events continue to occur from drug shortages, often resulting in inadequate patient care, high institutional costs, and patient complaints. Delayed care and cancelled care have been reported from shortages. Further research is necessary to better classify medication errors and adverse events during a drug shortage.

show abstract

“…Interestingly, there has been a recent shortage of the availability of 70 % ethanol for medical use in the United States, allowing for one group to investigate the rate of CBRSI during the shortage period. Eight children with IF went from daily ethanol use to less than daily (with a range of once or twice weekly), and the rate of CRBSI was 6.2 per 100 catheter days compared to 0.7 per 1,000 catheter days prior to the shortage (Ralls et al 2012). Ethanol lock therapy has the potential to play a very effective role in infection prevention in this patient population; however, without a prospective trial, there continue to be unanswered questions regarding the ideal dwell time and frequency.…”

Section: Ethanol Lock Therapy For Children With Intestinal Failurementioning

confidence: 99%

Use of Ethanol Lock Therapy for Children with Intestinal Failure on Long-Term Parenteral Nutrition

Piper

Wales

2015

Diet and Nutrition in Critical Care

View full text Add to dashboard Cite

Drug Shortage–Associated Increase in Catheter-Related Blood Stream Infection in Children

Abstract: ELT frequency reduction resulted in complete failure in CRBSI prophylaxis. The nationwide shortage of this drug has been costly both financially and in patient morbidity.

Cited by 35 publications

References 23 publications

Central Venous Access in the Pediatric Population With Emphasis on Complications and Prevention Strategies

Central Venous Access in the Pediatric Population With Emphasis on Complications and Prevention Strategies

Effects on Patient Care Caused by Drug Shortages: A Survey

Use of Ethanol Lock Therapy for Children with Intestinal Failure on Long-Term Parenteral Nutrition

Contact Info

Product

Resources

About