Failure mode and effects analysis to reduce risk of anticoagulation levels above the target range during concurrent antimicrobial therapy

Daniels, Lisa M.; Barreto, Jason N.; Kuth, John C.; Anderson, Jeremy R; Zhang, Beilei; Majka, Andrew J.; Morgenthaler, Timothy I.; Tosh, Pritish K.

doi:10.2146/ajhp140632

Cited by 6 publications

(4 citation statements)

References 21 publications

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“…If an intervention addressed an additional failure mode, this interventions’ additional benefit RPN was determined by the sum of the additional failure modes RPN the intervention addressed. 12 A Pareto diagram was created in order to visualize the potential impact of each additional intervention. The Pareto diagram charted each intervention with its individual RPN as well as by the cumulative percentage of the total RPN value affected by the additional intervention.…”

Section: Methodsmentioning

confidence: 99%

Practical Implementation of Failure Mode and Effects Analysis for Extracorporeal Membrane Oxygenation Activation

et al. 2018

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Extracorporeal membrane oxygenation (ECMO) is used to treat severe hypoxemic respiratory failure and as a rescue therapy for patients with cardiopulmonary arrest within a narrow window of time. A failure modes and effects analysis (FMEA) was conducted to analyze the clinical and operational processes leading to delays in initiating ECMO. FMEA determined these highest-risk failure modes that were contributing to process failure: (1) ECMO candidacy not determined in time, (2) no or incomplete evaluation for ECMO prior to consult or arrest, (3) ECMO team not immediately available, and (4) cannulation not completed in time. When implemented collectively, a total of 4 interventions addressed more than 95% of the system failures. These interventions were (1) ECMO response pager held by a team required for decision, (2) distribution of institutionally defined inclusion/exclusion criteria, (3) educational training for clinicians consulting the ECMO team, and (4) establishment of a mobile ECMO insertion cart.

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Section: Methodsmentioning

confidence: 99%

Practical Implementation of Failure Mode and Effects Analysis for Extracorporeal Membrane Oxygenation Activation

et al. 2018

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“…O risco de morte aumenta proporcionalmente ao valor de RNI 10 , portanto, o paciente em uso necessita de acompanha-mento clínico e laboratorial, com avaliação de equipe multidisciplinar 11 . A varfarina apresenta IM com diversos medicamentos, incluindo antimicrobianos (AM), com os quais apresenta IM significativas, através de diferentes mecanismos: inibição ou indução de isoenzimas do citocromo P450, competição por sítios de ligação a proteínas, ou redução da absorção de vitamina K, devido a alteração de microbiota intestinal, o que pode levar à falha terapêutica ou toxicidade 7,12 .…”

Section: Introductionunclassified

Concordância entre bases de dados sobre interações medicamentosas entre varfarina e antimicrobianos: uma análise descritiva.

Meregalli,

Da Silva Dal-Pizzol,

Mello de Oliveira

2024

JAFF

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Interações medicamentosas (IM) são eventos adversos que podem comprometer a efetividade terapêutica e a segurança do paciente. A varfarina está associada à IM relevantes com diversos medicamentos, incluindo antimicrobianos (AM). Objetivo: analisar concordância entre informações sobre mecanismo provável, classificação de gravidade e ma-nejo sugerido de IM potenciais entre varfarina e AM presentes na Relação Municipal de Medicamentos de Porto Alegre (REMUME/POA), nas bases de dados eletrônicas (BDE) UpToDate®, Drugs.com®, Medscape® e Micromedex®. Metodologia: análise descritiva de acordo com os Guidelines for Reporting Reliability and Agreement Studies. Resultados:Dos 15 AM, 13 apresentaram IM com varfarina em ao menos 01 das 04 BDE. Para a classificação da IM, a taxa de concordância total obtida nas 04 BDE consultadas foi de 33%; a concordância parcial entre 02 BDE foi de 33% e entre 03, também de 33%, e as BDE mais concordantes entre si foram UpToDate® e Drugs.com® (87%). Quanto ao mecanismo provável da IM, não houve concordância total entre as 04 BDE; a parcial entre 02 BDE foi de 38% e entre 03, de 23%, e as BDE mais concordantes entre si foram UpToDate® e Medscape® (38%). Para a sugestão de manejo clínico, a concordância total foi de 23%; a parcial entre 02 BDE foi de 38%, e entre 03, também de 38%. As BDE mais concordantes entre si foram UpToDate® e Drugs.com® (85%). Conclusão: As taxas de concordância total entre as BDE são relativamente baixas, mas a parcial é maior.

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“…Warfarin has been described to present signi cant DDI with are antimicrobials (AM). Several mechanisms have been studied: inhibition or induction of cytochrome P450 isoenzymes, competition for protein bond sites, or decreasing vitamin K absorption due to altered intestinal microbiota, representing a risk for therapeutic failure or toxicity [7,12].…”

Section: Introductionmentioning

confidence: 99%

Concordance rate amongst electronic databases regarded the information on potential drug interactions between warfarin and antimicrobials: a descriptive analysis

Meregalli

Pizzol

Oliveira

2022

Preprint

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Background: Although not always avoidable, drug-drug interaction (DDI) is an example of a predictable adverse event. Warfarin is a narrow therapeutic window oral anticoagulant that has been described to interact with antimicrobials (AM), affecting therapy efficacy and/or safety of anticoagulant and/or antimicrobial treatment. Aim: To evaluate the intrarater agreement on information about potential DDI between warfarin and AM present in the Municipal Essential Medicines List of Porto Alegre (REMUME/POA), Rio Grande do Sul, Brazil, between different electronic databases (EDB). Method: This descriptive analysis evaluated the EDB UpToDate®, Drugs.com®, Medscape®, and Micromedex® on information about DDI mechanism, severity classification, and clinical management. Results: Amongst the 20 AM listed, 17 had a potential DDI with warfarin described in at least one EDB. Total agreement rate between EDB regarding classification of DDI was 30%; as for partial concordance, rates among 2 and 3 EDB were respectively 25% and 45%. Most concordant EDB were UpToDate® and Drugs.com® (85%). For mechanism of DDI, the overall concordance rate was 12%; partial agreement was 35% and 23.5% on two and three EDB, respectively. Overall agreement rate for clinical management of DDI was 18%; partial agreement between 2 and 3 EDB was 29% and 53%, respectively. Conclusion: Overall concordance rate is relatively low, considering the information obtained for the three aspects evaluated. The partial concordance rate, however, is higher, reaching 45% of the drugs with concordant DDI classification for three out of four EDB. Further studies are needed to evaluate the robustness of the evidence employed by EDB.

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Failure mode and effects analysis to reduce risk of anticoagulation levels above the target range during concurrent antimicrobial therapy

Cited by 6 publications

References 21 publications

Practical Implementation of Failure Mode and Effects Analysis for Extracorporeal Membrane Oxygenation Activation

Practical Implementation of Failure Mode and Effects Analysis for Extracorporeal Membrane Oxygenation Activation

Concordância entre bases de dados sobre interações medicamentosas entre varfarina e antimicrobianos: uma análise descritiva.

Concordance rate amongst electronic databases regarded the information on potential drug interactions between warfarin and antimicrobials: a descriptive analysis

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