Healthcare Traveler - February 2009 - (Page 38)

Drug Update Sentinel event alert issued on anticoagulants he Joint Commission has issued a Sentinel Event Alert recommending that all healthcare staff who manage anticoagulants implement risk-reduction strategies to help prevent errors that can lead to patient harm or death. The alert states that anticoagulants account for 7.2% of medicationrelated sentinel events between 1997 and 2007, and that two-thirds of those involved heparin. Also noted in particular were warfarin (Coumadin) and enoxaparin (Lovenox). A total of 59,316 anticoagulant-related errors were reported between 2001 and 2006 to the U.S. Pharmacopeia Medmarx program, and nearly 3% of those errors resulted in harm or death, the authors wrote. The alert recommends that patients be carefully screened for contraindications and drug interactions, and that patients who are given anticoagulants be closely monitored to ensure effectiveness and prevent side effects or overdosing. Strategies outlined include a pharmacist-managed anticoagulation service and using computerized provider order entry and/or bar coding technology. The Joint Commission on Accreditation of Healthcare Organizations (2008). “Sentinel Event Alert: Preventing errors related to commonly used anticoagulants.” http://www.jointcommission.org/ SentinelEvents/SentinelEventAlert/sea_41.htm (24 Sept. 2008). T H E L AT E S T D E V E LO PM EN T S I N R E SE A RCH T Error Watch Symbols cause > average chance of making error octors and nurses should not use symbols such as the ones for “greater than” or “less than” to communicate information regarding medications, as it increases the risk of error, according to the Institute for Safe Medication Practices (ISMP). In one example, a physician prescribed metoprolol for a blood pressure of 160/90 or higher in a hypertensive patient, and said it was to be held if the patient’s heart rate dropped below 60 beats per minute. A pharmacist entered the order as “Give for D BP > or = 160/90 and hold for HR < 60.” The nurse following the order confused the symbols and gave the drug when it should have been held, and the patient’s blood pressure dropped to a dangerously low level. The ISMP advises that “greater than” and “less than” should be written in text, and added to each facility’s list of unacceptable abbreviations. Safety Wire: Greater than or less than? (2008). Nurse Advise-ERR, 6(9), 1. Anticholinergic agents increase some risks for COPD patients P RN Corner Drug Update… Professional Update… Advice of Counsel… 38 Healthcare Traveler February 2009 38 40 43 atients who used inhaled anticholinergic agents for at least a month to treat their chronic obstructive pulmonary disease (COPD) showed a 58% increase in risk of cardiovascular death, myocardial infarction, or stroke, when compared with those who took a placebo or other inhaled agents, according to the results of a 17-trial meta-analysis published in the Sept. 24 issue of the Journal of the American Medical Association. The risk of CV death alone was 80% higher with the drugs studied, though overall numbers of CV deaths were low. The study authors, led by Dr. Sonal Singh of Wake Forest University, screened 17 randomized trials that ranged from six weeks to five years, involving 14,783 patients who took inhaled anticholinergic agents ipratropium bromide (Atrovent), ipratropium bromide combined with albuterol (Combivent), tiotropium bromide (Spiriva), or a control therapy, which could include placebo or inhaled beta agonists. Trials that included asthmatic patients were not part of the meta-analysis. Heart Wire. “Inhaled anticholinergics for COPD raise CV-event risk in meta-analysis.” 2008. http://www.theheart.org/article/906953.do (23 Sept. 2008) This department originally appeared in RN, a sister publication. For subscription information, call 800-284-8945 or visit www.rnweb.com. www.healthcaretraveler.com Photo: Getty Images/Jorg Greuel http://www.jointcommission.org/SentinelEvents/SentinelEventAlert/sea_41.htm http://www.jointcommission.org/SentinelEvents/SentinelEventAlert/sea_41.htm http://www.theheart.org/article/906953.do http://www.rnweb.com http://www.healthcaretraveler.com

Table of Contents Feed for the Digital Edition of Healthcare Traveler - February 2009

Healthcare Traveler - February 2009 Editor’s Desk Contents In a Flash Paws for Thought Field Notes Med Ec-cerpts The Economic Meltdown What Really is a “Tax Home”? Beach Therapy Drug Update Professional Update Advice of Counsel Cityscape Advertisers’ Index Name It Contest Rules On Assignment Tax Facts Dot.com Big Deals Allied Corner Going the Distance Classifieds Tales from the Road

Healthcare Traveler - February 2009

For optimal viewing of this digital publication, please enable JavaScript and then refresh the page. If you would like to try to load the digital publication without using Flash Player detection, please click here.