Enoxaparin dosing errors in the emergency department

Abstract

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.

In-Hospital Patient Harm Across Linguistic Groups: A Retrospective Cohort Study of Home Care Recipients

“…In the first study, French-speaking patients treated by nonnative French-speaking health care providers were more likely to have their medication incorrectly reconstituted 25 . The second study showed that English-speaking patients in a hospital where the predominant language was English were more likely to experience a medication dosing error, 21 whereas the third did not find an association between patient language and medication errors among hospitalized patients in Israel 22 . Other studies examining the risk of harm among hospitalized, nonobstetric patients have not shown a difference in the risk of harm across linguistic groups 23,26 .…”

“…16,17 This large-scale population-based study included 311,131 hospitalizations, thus allowing us to obtain more precise and reliable estimates than previous studies. 16,[21][22][23]25,26 Studies conducted in the United States have shown that non-English-speaking women have a higher risk of obstetric trauma, 18,20 whereas pediatric patients from Spanish-speaking families have a higher risk of serious adverse events. 16,17 Three studies have also considered the impact of patient-provider language discordance on the rate of medication errors.…”

“…The use of this methodology, which was developed and validated by CIHI, 2 minimized the possibility of bias, especially in comparison to previous studies that relied on manual abstraction of hospital charts, 21–23,26 or reporting by health care providers and/or patients 16,17 . This large-scale population-based study included 311,131 hospitalizations, thus allowing us to obtain more precise and reliable estimates than previous studies 16,21–23,25,26 . Studies conducted in the United States have shown that non–English-speaking women have a higher risk of obstetric trauma, 18,20 whereas pediatric patients from Spanish-speaking families have a higher risk of serious adverse events 16,17 .…”

“…Our study used the Hospital Harm Indicator to identify harmful events from discharge documentation. The use of this methodology, which was developed and validated by CIHI, 2 minimized the possibility of bias, especially in comparison to previous studies that relied on manual abstraction of hospital charts, 21–23,26 or reporting by health care providers and/or patients 16,17 . This large-scale population-based study included 311,131 hospitalizations, thus allowing us to obtain more precise and reliable estimates than previous studies 16,21–23,25,26 .…”

“…International studies show that patients who face language barriers are more likely to have longer stays in emergency departments and in hospitals, 8–11 be admitted or readmitted to hospital, 11–13 be discharged without understanding follow-up instructions, 14,15 and experience harm in hospital 16–20 . Previous studies on harm have only considered specific types of harmful events (i.e., medication error, obstetric trauma) and have been limited by inaccurate measurement of patients’ language, inadequate adjustment of confounding variables, small sample sizes, and/or subjective reporting of harmful events 16–26 . To date, no study has considered the relationship between patient-provider language concordance/discordance and the risk of harm among frail, older patients, despite the fact that this population has an increased risk of experiencing harm 5,27,28 .…”