Medication errors involving continuously infused medications in a surgical intensive care unit

Herout, Peter; Erstad, Brian L.

doi:10.1097/01.ccm.0000108876.12846.b7

Cited by 84 publications

(60 citation statements)

References 21 publications

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“…Many e-prescribing systems can also check formulary information to determine if a selected medication is covered by a patient's insurance, thereby decreasing patient drug cost and increasing both patient and physician compliance with insurers' preferred-drug prescription programs. [5][6][7][8][9] Additional information is available in the accompanying technical report on e-prescribing. 4 Research examining the impact of e-prescribing on reducing malpractice claims might result in a commensurate reduction in malpractice www.pediatrics.org/cgi…”

Section: Statement Of Problemmentioning

confidence: 99%

“…Because safety for children is paramount, e-prescribing systems used for the care of children should include, at a minimum, pediatric-specific decision support such as weight-based dose calculations and alerts and pediatric drug information and formulation options. 3,7,[15][16][17] When possible, e-prescribing systems should be implemented as part of a robust electronic health record. Such implementations offer advantages well beyond those of freestanding e-prescribing systems.…”

Section: Recommendationsmentioning

confidence: 99%

“…[5][6][7][8][9] However, as with any new technology, the use of these systems may have unintended consequences or novel risks that will need to be monitored and studied over time.…”

Section: Summary/conclusionmentioning

confidence: 99%

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Electronic Prescribing Systems in Pediatrics: The Rationale and Functionality Requirements

2007

Pediatrics

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The use of electronic prescribing applications in pediatric practice, as recommended by the federal government and other national health care improvement organizations, should be encouraged. Legislation and policies that foster adoption of electronic prescribing systems by pediatricians should recognize both specific pediatric requirements and general economic incentives required to speed the adoption of these systems. Continued research into improving the effectiveness of these systems, recognizing the unique challenges of providing care to the pediatric population, should be promoted. BACKGROUNDThe American Academy of Pediatrics (AAP) is committed to providing the best and safest health care system possible for children. Statement of ProblemThe AAP recognizes that the "increasing complexity in patient care in addition to the public's increased scrutiny of the health care system underscores the need to make patient safety an issue of high priority." 1 The AAP supports national efforts to improve patient safety and the recommendations of the Institute of Medicine, the Institute for Safe Medical Practices, the Leapfrog Group, and others who encourage the implementation and use of electronic prescribing (e-prescribing) by physicians as a method to improve patient safety. 2,3 New Information E-prescribing systems reduce transcription errors by eliminating illegible prescriptions. Computerized decision support can ensure that prescriptions are checked for drug-drug and drug-allergy interactions before the prescription is written. Dosage calculators can ensure that the correct dose of medication is given on the basis of patient age and weight, and dose-range checking can alert prescribers when doses outside the predetermined ranges are prescribed. Many e-prescribing systems can also check formulary information to determine if a selected medication is covered by a patient's insurance, thereby decreasing patient drug cost and increasing both patient and physician compliance with insurers' preferred-drug prescription programs. [5][6][7][8][9] Additional information is available in the accompanying technical report on e-prescribing. 4 Research examining the impact of e-prescribing on reducing malpractice claims might result in a commensurate reduction in malpractice www.pediatrics.org/cgi

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Section: Statement Of Problemmentioning

confidence: 99%

Section: Recommendationsmentioning

confidence: 99%

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Electronic Prescribing Systems in Pediatrics: The Rationale and Functionality Requirements

2007

Pediatrics

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“…Medications in adults that require weight-based calculation (the norm for pediatric patients) were found to be more error prone. 29,30 Process factors, including the need for individualized dilution of stock medications and fluids (because of weight and body surface area considerations), place children at increased risk of medication errors in comparison with adults. Location-specific factors, such as the fast pace and high complexity in ICUs, are associated with a sevenfold risk of medication errors.…”

Section: Pediatric Studiesmentioning

confidence: 99%

Electronic Prescribing Systems in Pediatrics: The Rationale and Functionality Requirements

Gerstle¹,

Lehmann²

2007

Pediatrics

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This technical report discusses electronic prescribing systems and their limitations and potential benefits, particularly to the pediatrician in the ambulatory setting. In the report we acknowledge the benefits of integrating these systems with electronic health records and practice-management systems and recommend that the adoption of electronic prescribing systems be done in the context of ultimately moving toward an electronic health record. This technical report supports the accompanying American Academy of Pediatrics policy-statement recommendations on the adoption of electronic prescribing systems by pediatricians.

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“…This finding was consistent with the results of other ICU studies. 12,13 Medication errors most likely to result in serious outcomes include intravenous medications; medications given in specialty areas, such as ICUs; and medications with complex dosing regimens. 14,15 Intravenous prostacyclins meet all of these criteria.…”

mentioning

confidence: 99%

Safety Recommendations for Administering Intravenous Prostacyclins in the Hospital

Kingman

Chin²

2013

Critical Care Nurse

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P ulmonary arterial hypertension (PAH) is a rare disease characterized by vasoconstriction and proliferation of the small pulmonary arteries, changes that eventually lead to right-sided heart failure and death in most patients who have the disease. 1 When PAH is diagnosed early in the course of the disease, initial treatment usually consists of oral therapy, including phosphodiesterase type 5 inhibitors and endothelin receptor antagonists.2 Intravenous epoprostenol sodium (Flolan), epoprostenol for injection (Veletri), and treprostinil (Remodulin) are intravenous prostacyclins given as continuous infusions in the most advanced cases of PAH.1 Prostacyclins are potent vasodilators, inhibit platelet activation, and have antiproliferative effects on smooth muscle and intimal cells. Intravenous prostacyclins are expensive and require a comprehensive insurance approval process. Once approved, the drugs are commonly started in the hospital at a dose of 1.25 to 2 ng/kg per minute via a dedicated central catheter, and the dose is increased according to the signs and symptoms of PAH Safety Recommendations for Administering Intravenous Prostacyclins in the Hospital MARTHA S. KINGMAN, DNP, FNP-C KELLY CHIN, MD FeatureProstacyclins are a high-risk category of continuous intravenous infusions increasingly used in hospitals to treat advanced pulmonary arterial hypertension, a rare condition characterized by vasoconstriction and vascular proliferation of the pulmonary arteries. Prostacyclins are given in doses of nanograms per kilogram per minute and have a narrow therapeutic dosing range for each patient. Sudden increases or decreases in dose can be life threatening. Previous studies revealed errors in the administration of these high-risk infusions, which in some instances led to serious adverse events, including death. The literature was reviewed for safety measures in administration of high-risk intravenous medications and input was obtained from leading experts in pulmonary arterial hypertension to create a set of safety recommendations for infusion of prostacyclins. (Critical Care Nurse. 2013;33[5]:32-34,36-41) ©2013 American Association of Critical-Care Nurses doi: http://dx.doi. org/10.4037/ccn2013608 This article has been designated for CNE credit. A closed-book, multiple-choice examination follows this article, which tests your knowledge of the following objectives:1. Distinguish between adverse effects of prostacyclins and symptoms of pulmonary artery hypertension 2. Summarize 4 approaches to prevent errors associated with high-risk medications 3. Describe 3 safety recommendations that reduce error during prostacyclin administration and the side effects of the prostacyclin being administered. Dosing is generally highly individualized according to the severity of the disease and how well patients are able to tolerate the side effects of the drug. Common side effects include headache, jaw pain, flushing, nausea, diarrhea, rash, and pain in the extremities.3 Signs and symptoms of PAH include shortness of breath, c...

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Medication errors involving continuously infused medications in a surgical intensive care unit

Cited by 84 publications

References 21 publications

Electronic Prescribing Systems in Pediatrics: The Rationale and Functionality Requirements

Electronic Prescribing Systems in Pediatrics: The Rationale and Functionality Requirements

Electronic Prescribing Systems in Pediatrics: The Rationale and Functionality Requirements

Safety Recommendations for Administering Intravenous Prostacyclins in the Hospital

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