Optimization of Antibacterial Therapy to Minimize Costs, Medication Errors, and Adverse Outcomes

e13609 Background: Drug shortages are a clear and growing challenge. Prominent shortages included oncology medications and supportive care products essential for the care of cancer patients. Oncology drug shortages often result in disruptions in the timing of chemotherapy treatments, alterations in the dose or regimen administered, or even missed doses when alternative agents are unavailable. The purpose of this survey was to characterize the impact of oncology drug shortages across the United States, including the experiences of health care organizations, resource implications, and the impact on patient safety, patient care, and clinical trials. Methods: A 34-item online survey was distributed to HOPA membership of the Hematology Oncology Pharmacy Association to gather information on shortages of oncology drugs (i.e., all drugs essential in the care of cancer patients, including supportive care agents. Results: Sixty-eight organizations completed the survey; almost all completed by pharmacists, and analysis completed. Sixty-three percent of institutions reported one or more drugs shortages a month, with a 34.33% increase in 2019 from 2018. Sixty four percent of responded had incurred increased costs from oncology drugs shortages, with 7% noting reimbursement issues when switched to brand name therapies due to shortages. Treatment delays, reduced doses or alternative regimens were reported by 74.63% of respondents. The most common disease states which causes a dose delay of treatment included Acute Lymphocytic Leukemia, Lymphoma and Multiple Myeloma with dose reductions noted in 36.36%, 36.36 and 15.91%. The top five oncology drugs on shortage included epirubicin, flutamide, decitabine, mechlorethamine, dactinomycin with the top 5 supportive care drugs on shortage being noted as hydrocortisone, bivalirudin, promethazine, mycophenolate sodium and scopolamine. Respondents noted medication errors related to oncology drug shortages at 4.48%, with noted errors including incorrect conversion from iv to oral etoposide and incorrect EMR drug builds. Oncology Drug shortages impacted clinical trials in 13.4% of respondents in which 54.55% of respondents noting patients not being enrolled in clinical trials. Conclusions: A survey of US oncology pharmacists and technicians indicated that oncology drug shortages occurred frequently in 2020. Shortages led to delays in chemotherapy and changes in treatment or omission, complicated clinical research and increased the risk of medication errors and adverse outcomes.

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Systematic Steps to Diminish Multi-Fold Medication Errors in Neonates

The Journal of Pediatric Pharmacology and Therapeutics ◽

10.5863/1551-6776-8.4.266 ◽

2003 ◽

Vol 8 (4) ◽

pp. 266-273 ◽

Cited By ~ 1

Author(s):

Joaquim M. B. Pinheiro ◽

Amy L. Mitchell ◽

Timothy S. Lesar

Keyword(s):

Intensive Care Unit ◽

Medication Errors ◽

Neonatal Intensive Care ◽

Human Error ◽

Error Reduction ◽

Adverse Outcomes ◽

Order Entry ◽

Multiple Dosing ◽

Computerized Order Entry ◽

Order Entry Systems

Tenfold and other multiple-of-dose errors are particularly common in the neonatal intensive care unit (NICU), where the fragility of the patients increases the potential for significant adverse outcomes. Such errors can originate at any of the sequential phases of the process, from medication ordering to administration. Each step of calculation, prescription writing, transcription, dose preparation, and administration is an opportunity for generating and preventing medication errors. A few simple principles and practical tips aimed at avoiding decimal and other multiple-dosing errors can be systematically implemented through the various steps of the process. The authors describe their experience with the implementation of techniques for error reduction in a NICU setting. The techniques described herein rely on simple, inexpensive technologies for information and automation, and on standardization and simplification of processes. They can be immediately adapted and applied in virtually any NICU and could be integrated into the development of computerized order entry systems appropriate to NICU settings. Either way, they should decrease the likelihood of undetected human error.

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Analgesic-Related Medication Errors Reported to US Poison Control Centers

Pain Medicine ◽

10.1093/pm/pnx272 ◽

2017 ◽

Vol 19 (12) ◽

pp. 2357-2370 ◽

Cited By ~ 1

Author(s):

Madhulika Eluri ◽

Henry A Spiller ◽

Marcel J Casavant ◽

Thitphalak Chounthirath ◽

Kristen A Conner ◽

...

Keyword(s):

Medication Errors ◽

Error Rate ◽

Care Facility ◽

Health Care Facility ◽

Adverse Outcomes ◽

Poison Control ◽

Model Combining ◽

Clinical Consequences ◽

National Poison Data System ◽

Design And Methods

Abstract Objective This study investigates the characteristics and trends of medication errors involving analgesic medications. Design and Methods A retrospective analysis was conducted of analgesic-related medication errors reported to the National Poison Data System (NPDS) from 2000 through 2012. Results From 2000 through 2012, the NPDS received 533,763 reports of analgesic-related medication errors, averaging 41,059 medication errors annually. Overall, the rate of analgesic-related medication errors reported to the NPDS increased significantly by 82.6% from 2000 to 2009, followed by a 5.7% nonsignificant decrease from 2009 to 2012. Among the analgesic categories, rates of both acetaminophen-related and opioid-related medication errors reported to the NPDS increased during 2000–2009, but the opioid error rate leveled off during 2009–2012, while the acetaminophen error rate decreased by 17.9%. Analgesic-related medication errors involved nonsteroidal anti-inflammatory drugs (37.0%), acetaminophen (35.5%), and opioids (23.2%). Children five years or younger accounted for 38.8% of analgesics-related medication errors. Most (90.2%) analgesic-related medication errors were managed on-site, rather than at a health care facility; 1.6% were admitted to a hospital, and 1.5% experienced serious medical outcomes, including 145 deaths. The most common type of medication error was inadvertently taking/given the medication twice (26.6%). Conclusion Analgesic-related medication errors are common, and although most do not result in clinical consequences, they can have serious adverse outcomes. Initiatives associated with the decrease in acetaminophen-related medication errors among young children merit additional research and potential replication as a model combining government policy and multisectoral collaboration.

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Research Consumerism 101: Evaluating External Evidence of Treatment Effectiveness

Perspectives on Swallowing and Swallowing Disorders (Dysphagia) ◽

10.1044/sasd17.2.43 ◽

2008 ◽

Vol 17 (2) ◽

pp. 43-49

Author(s):

James L. Coyle

Keyword(s):

Treatment Effectiveness ◽

Code Of Ethics ◽

Oropharyngeal Dysphagia ◽

Clinical Importance ◽

Professional Services ◽

Adverse Outcomes ◽

Professional Judgment ◽

Evidence Based ◽

Intervention Selection ◽

Published Research

Abstract The modern clinician is a research consumer. Rehabilitation of oropharyngeal impairments, and prevention of the adverse outcomes of dysphagia, requires the clinician to select interventions for which evidence of a reasonable likelihood of a successful, important outcome exists. The purpose of this paper is to provide strategies for evaluation of published research regarding treatment of oropharyngeal dysphagia. This article utilizes tutorial and examples to inform and educate practitioners in methods of appraising published research. It provides and encourages the use of methods of efficiently evaluating the validity and clinical importance of published research. Additionally, it discusses the importance of the ethical obligation we, as practitioners, have to use evidence-based treatment selection methods and measurement of patient performance during therapy. The reader is provided with tactics for evaluating treatment studies to establish a study's validity and, thereby, objectively select interventions. The importance of avoiding subjective or unsubstantiated claims and using objective methods of generating empirical clinical evidence is emphasized. The ability to evaluate the quality of research provides clinicians with objective intervention selection as an important, essential component of evidence-based clinical practice. ASHA Code of Ethics (2003): Principle I, Rule F: “Individuals shall fully inform the persons they serve of the nature and possible effects of services rendered and products dispensed…” (p. 2) Principle I, Rule G: “Individuals shall evaluate the effectiveness of services rendered and of products dispensed and shall provide services or dispense products only when benefit can reasonably be expected.” (p. 2) Principle IV, Rule G: “Individuals shall not provide professional services without exercising independent professional judgment, regardless of referral source or prescription.” (p. 4)

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