Medication errors recovered by emergency department pharmacists.

STUDY OBJECTIVE: We assess the impact of emergency department (ED) pharmacists on reducing potentially harmful medication errors. METHODS: We conducted this observational study in 4 academic EDs. Trained pharmacy residents observed a convenience sample of ED pharmacists' activities. The primary outcome was medication errors recovered by pharmacists, including errors intercepted before reaching the patient (near miss or potential adverse drug event), caught after reaching the patient but before causing harm (mitigated adverse drug event), or caught after some harm but before further or worsening harm (ameliorated adverse drug event). Pairs of physician and pharmacist reviewers confirmed recovered medication errors and assessed their potential for harm. Observers were unblinded and clinical outcomes were not evaluated. RESULTS: We conducted 226 observation sessions spanning 787 hours and observed pharmacists reviewing 17,320 medications ordered or administered to 6,471 patients. We identified 504 recovered medication errors, or 7.8 per 100 patients and 2.9 per 100 medications. Most of the recovered medication errors were intercepted potential adverse drug events (90.3%), with fewer mitigated adverse drug events (3.9%) and ameliorated adverse drug events (0.2%). The potential severities of the recovered errors were most often serious (47.8%) or significant (36.2%). The most common medication classes associated with recovered medication errors were antimicrobial agents (32.1%), central nervous system agents (16.2%), and anticoagulant and thrombolytic agents (14.1%). The most common error types were dosing errors, drug omission, and wrong frequency errors. CONCLUSION: ED pharmacists can identify and prevent potentially harmful medication errors. Controlled trials are necessary to determine the net costs and benefits of ED pharmacist staffing on safety, quality, and costs, especially important considerations for smaller EDs and pharmacy departments.

Electronic alerts for hospitalized high-VTE risk patients not receiving prophylaxis: a cohort study.

BACKGROUND: Despite existing consensus guidelines, venous thromboembolism (VTE) prophylaxis is underused in high-risk hospitalized patients. The present study evaluated the effects of an electronic alert to the responsible physician in a cohort of hospitalized high-risk patients not receiving VTE prophylaxis. METHODS: The absence of VTE prophylaxis orders in hospitalized patients at high-risk for VTE triggered an electronic alert to the responsible physician. We studied a cohort of 866 patients whose physicians were alerted that their patients were at high-risk but receiving no VTE prophylaxis. The electronic alert recommended that the responsible physician order preventive measures. We followed each patient for 90 days to determine whether imaging-confirmed symptomatic VTE occurred. RESULTS: 9,527 patients were identified as high-risk for VTE. 9% (866) were not receiving prophylaxis, compared with 18% in the intervention arm of a previous randomized trial (P < 0.001). In our current cohort study, 82% (713) of patients were Medical Service patients. Physician response to alerts resulted in prophylactic measures for 37.7% of those alerted. Symptomatic VTE at 90 days occurred in 5.1% of patients in the present cohort group. CONCLUSION: Implementation of a computer alert program increased prophylaxis rates. However, the majority of alerted physicians in the cohort study did not order VTE prophylaxis despite the alerts. Therefore, novel strategies must be employed to further improve the use of VTE prophylaxis in hospitalized high-risk patients, especially in Medical Service patients.

Observations on the use of ready-to-use and point-of-care activated parenteral products in automated dispensing cabinets in U.S. hospitals.

PURPOSE: The use of ready-to-use (RTU) and point-of-care (POC) activated parenteral products and their storage in automated dispensing cabinets (ADCs) in U.S. hospitals were evaluated. METHODS: A survey on the use of RTU and POC activated parenteral products, including storage and dispensing of the products, was developed and sent electronically to hospital pharmacy administrators. Survey respondents were identified using the American Society of Health-System Pharmacists' member database. RESULTS: Of the 4070 surveys sent, 965 (23.7%) were completed and returned. Most pharmacy administrators (94.7%) reported that their institution used some form of RTU and POC activated parenteral product, with 74% using ADCs to dispense these products. Efficiency was the most common reason cited for storage of RTU and POC activated products in ADCs. Facilities varied on reasons for not implementing this technology, with 47 facilities citing implementation costs, limited number of RTU and POC activated products on the hospital's formulary, lack of available pediatric formulations, and safety concerns as the main reasons. More than half of respondents noted space limitations as the greatest challenge to adding RTU and POC activated products to ADCs. CONCLUSION: Nearly three fourths of survey respondents reported using RTU and POC products in conjunction with ADCs; however, the approach to including these products in ADCs varied based on the characteristics, policies, and preferences of the individual facility. Advantages of RTU and POC products identified by respondents included enhanced safety benefits, increased dispensing efficiency, cost avoidance due to reduced waste, and improved compliance with federal and state regulations.

A review of dietary supplement-induced renal dysfunction.

Complementary and alternative medicine (CAM) is a multibillion-dollar industry. Almost half of the American population uses some form of CAM, with many using them in addition to prescription medications. Most patients fail to inform their health care providers of their CAM use, and physicians rarely inquire. Annually, thousands of dietary supplement-induced adverse events are reported to Poison Control Centers nationwide. CAM manufacturers are not responsible for proving safety and efficacy, because the Food and Drug Administration does not regulate them. However, concern exists surrounding the safety of CAM. A literature search using MEDLINE and EMBASE was undertaken to explore the impact of CAM on renal function. English-language studies and case reports were selected for inclusion but were limited to those that consisted of human subjects, both adult and pediatric. This review provides details on dietary supplements that have been associated with renal dysfunction and focuses on 17 dietary supplements that have been associated with direct renal injury, CAM-induced immune-mediated nephrotoxicity, nephrolithiasis, rhabdomyolysis with acute renal injury, and hepatorenal syndrome. It is concluded that it is imperative that use of dietary supplements be monitored closely in all patients. Health care practitioners must take an active role in identifying patients who are using CAM and provide appropriate patient education.