scholarly journals Reducing error in anticoagulant dosing via multidisciplinary team rounding at point of care

2017 ◽  
Vol 7 (2) ◽  
Author(s):  
Munish Sharma ◽  
Mahesh Krishnamurthy ◽  
Richard Snyder ◽  
James Mauro
Keyword(s):  
Renal Function ◽  
Patient Safety ◽  
Electronic Medical Records ◽  
Clinical Pharmacist ◽  
Medical Records ◽  
Therapeutic Response ◽  
Adverse Drug Events ◽  
Point Of Care ◽  
Bleeding Diathesis ◽  
Dosage Error

The incorporation of a clinical pharmacist in daily rounding can help identify and correct errors related to anticoagulation dosing. Inappropriate anticoagulant dosing increases the risk of developing significant bleeding diathesis. Conversely, inappropriate dosing may also fail to produce a therapeutic response. We retrospectively reviewed electronic medical records of 41 patients to confirm and analyze the errors related to various anticoagulants. A clinical pharmacist in an integrated rounding between the period of February 2016 and April 2016 collected this data. We concluded that integrated rounding improves patient safety by recognizing anticoagulant dosage error used for the purpose of prophylaxis or treatment. It also allows us to make dose adjustments based on renal function of the patient. We think that it is prudent for physicians to pay particular attention to creatinine clearance when dosing anticoagulants in order to achieve the intended dosing effect and reduce the risk of adverse drug events.

scholarly journals IT-CARES: an interactive tool for case-crossover analyses of electronic medical records for patient safety

2016 ◽  
Vol 24 (2) ◽  
pp. 323-330 ◽  
Author(s):  
Alexandre Caron ◽  
Emmanuel Chazard ◽  
Joris Muller ◽  
Renaud Perichon ◽  
Laurie Ferret ◽  
...  
Keyword(s):  
Patient Safety ◽  
User Interface ◽  
Adverse Events ◽  
Electronic Medical Records ◽  
Medical Records ◽  
Medical Procedures ◽  
Odds Ratios ◽  
Hand Column ◽  
Case Crossover ◽  
Interactive Tool

Background: The significant risk of adverse events following medical procedures supports a clinical epidemiological approach based on the analyses of collections of electronic medical records. Data analytical tools might help clinical epidemiologists develop more appropriate case-crossover designs for monitoring patient safety. Objective: To develop and assess the methodological quality of an interactive tool for use by clinical epidemiologists to systematically design case-crossover analyses of large electronic medical records databases. Material and Methods: We developed IT-CARES, an analytical tool implementing case-crossover design, to explore the association between exposures and outcomes. The exposures and outcomes are defined by clinical epidemiologists via lists of codes entered via a user interface screen. We tested IT-CARES on data from the French national inpatient stay database, which documents diagnoses and medical procedures for 170 million inpatient stays between 2007 and 2013. We compared the results of our analysis with reference data from the literature on thromboembolic risk after delivery and bleeding risk after total hip replacement. Results: IT-CARES provides a user interface with 3 columns: (i) the outcome criteria in the left-hand column, (ii) the exposure criteria in the right-hand column, and (iii) the estimated risk (odds ratios, presented in both graphical and tabular formats) in the middle column. The estimated odds ratios were consistent with the reference literature data. Discussion: IT-CARES may enhance patient safety by facilitating clinical epidemiological studies of adverse events following medical procedures. The tool’s usability must be evaluated and improved in further research.

Perspectives on Electronic Prescribing and Terminologies

2013 ◽  
pp. e370-e373
Author(s):  
David Liebovitz
Keyword(s):  
Patient Safety ◽  
Electronic Medical Records ◽  
Medical Records ◽  
International Classification Of Diseases ◽  
Population Based ◽  
Electronic Prescribing ◽  
Medication History ◽  
Diagnosis Codes ◽  
Classification Of Diseases ◽  
Potential Benefits

Electronic medical records provide potential benefits and also drawbacks. Potential benefits include increased patient safety and efficiency. Potential drawbacks include newly introduced errors and diminished workflow efficiency. In the patient safety context, medication errors account for significant patient harm. Electronic prescribing (e-prescribing) offers the promise of automated drug interaction and dosage verification. In addition, the process of enabling e-prescriptions also provides access to an often unrecognized benefit, that of viewing the dispensed medication history. This information is often critical to understanding patient symptoms. Obtaining significant value from electronic medical records requires use of standardized terminology for both targeted decision support and population-based management. Further, generating documentation for a billable encounter requires usage of proper codes. The emergence of International Classification of Diseases (ICD)-10 holds promise in facilitating identification of a more precise patient code while also presenting drawbacks given its complexity. This article will focus on elements of e-prescribing and use of structured chart content, including diagnosis codes as they relate to physician office practices.

scholarly journals Improvement of patient safety through implementation of electronic medical records

2017 ◽  
Vol 1 (4) ◽  
pp. 111-112
Author(s):  
Elahe Gozali ◽  
Marjan Ghazisaiedi ◽  
Malihe Sadeghi ◽  
Reza Safdari
Keyword(s):  
Patient Safety ◽  
Medical Record ◽  
Electronic Medical Record ◽  
Electronic Medical Records ◽  
Medical Records ◽  
Access To Health Care ◽  
Clinical Care ◽  
Drug Management ◽  
Bar Code

Introduction: Today, with the complexity of the process of conducting activities, the increase in diversity and the number of hospital services, and the increase in the expectations of clients - consistent with the fast technological advances - most of the hospitals in Iran have turned to mechanized systems to organize their daily activities and to register the patients' information and the care provided. One of these technologies is electronic medical records, which is known as a valuable system to evaluate patients' information in hospitals. The purpose of this paper was to examine the advantages of running electronic medical records in patient safety. Methods: This study is a review paper based on a structured review of papers published in the Google Scholar, SID, Magiran, Pubmed, and Science Direct databases (from 2007 to 2015) and the books on the benefits of implementing electronic medical records in patient safety and the related keywords. Results: Clinical information systems can have a significant effect on the quality of the outputs and patient safety. Various studies have indicated that the physicians with access to clinical guidelines and features such as computer reminders, doctors who did not have these features, presented more appropriate preventive care. Studies show that electronic medical records play a crucial role in improving the quality of patient health and safety services. Moreover, electronic medical record system is usually in connection with other technological tools: electronic drug management records,  electronic record of time and date of drug management are usually associated with bar code technology. Among the benefits of this system is the possibility to record clinical care by the treatment team, which would be especially beneficial for patient's bedside record. If the treatment personnel forgets to ask the patient a particular question, system reminds him/her. Furthermore, electronic medical record is able to remind the nurses of the patient's allergic reactions and medical history without the need for the patient to remind, which improves patient safety. Conclusion: Implementation of electronic medical records boosts up the quality of health services, patient safety, people's access to health care services, and the speed of patients treatment, leading to lower healthcare costs. Thus, considering the benefits mentioned and some other benefits of this kind, one can use this technology in clinical care provided to patients to come up with a safe and effective clinical care.

scholarly journals Comparison of Efficacy and Safety of Rosuvastatin, Atorvastatin and Pravastatin among Dyslipidemic Diabetic Patients

2013 ◽  
Vol 2013 ◽  
pp. 1-7 ◽  
Author(s):  
Lolwa Barakat ◽  
Amin Jayyousi ◽  
Abdulbari Bener ◽  
Bilal Zuby ◽  
Mahmoud Zirie
Keyword(s):  
Renal Function ◽  
Electronic Medical Records ◽  
Medical Records ◽  
Large Scale ◽  
Population Based ◽  
Diabetic Patients ◽  
Population Based Study ◽  
Number Of Patients ◽  
Second Year ◽  
New Onset

Objectives. To investigate the efficacy and the safety of the three most commonly prescribed statins (rosuvastatin, atorvastatin, and pravastatin) for managing dyslipidemia among diabetic patients in Qatar. Subjects and Methods. This retrospective observational population-based study included 350 consecutive diabetes patients who were diagnosed with dyslipidemia and prescribed any of the indicated statins between September 2005 and September 2009. Data was collected by review of the Pharmacy Database, the Electronic Medical Records Database (EMR viewer), and the Patient's Medical Records. Comparisons of lipid profile measurements at baseline and at first- and second-year intervals were taken. Results. Rosuvastatin (10 mg) was the most effective at reducing LDL-C (29.03%). Atorvastatin reduced LDL-C the most at a dose of 40 mg (22.8%), and pravastatin reduced LDL-C the most at a dose of 20 mg (20.3%). All three statins were safe in relation to muscular and hepatic functions. In relation to renal function, atorvastatin was the safest statin as it resulted in the least number of patients at the end of 2 years of treatment with the new onset of microalbuminuria (10.9%) followed by rosuvastatin (14.3%) and then pravastatin (26.6%). Conclusion. In the Qatari context, the most effective statin at reducing LDL-C was rosuvastatin 10 mg. Atorvastatin was the safest statin in relation to renal function. Future large-scale prospective studies are needed to confirm these results.

scholarly journals A method for systematic discovery of adverse drug events from clinical notes

2015 ◽  
Vol 22 (6) ◽  
pp. 1196-1204 ◽  
Author(s):  
Guan Wang ◽  
Kenneth Jung ◽  
Rainer Winnenburg ◽  
Nigam H Shah
Keyword(s):  
Electronic Medical Records ◽  
Medical Records ◽  
Adverse Drug Events ◽  
Area Under The Curve ◽  
Data Sources ◽  
Clinical Notes ◽  
Post Marketing Surveillance ◽  
Post Marketing ◽  
Harmful Effects ◽  
Positive Support

Abstract Objective Adverse drug events (ADEs) are undesired harmful effects resulting from use of a medication, and occur in 30% of hospitalized patients. The authors have developed a data-mining method for systematic, automated detection of ADEs from electronic medical records. Materials and Methods This method uses the text from 9.5 million clinical notes, along with prior knowledge of drug usages and known ADEs, as inputs. These inputs are further processed into statistics used by a discriminative classifier which outputs the probability that a given drug–disorder pair represents a valid ADE association. Putative ADEs identified by the classifier are further filtered for positive support in 2 independent, complementary data sources. The authors evaluate this method by assessing support for the predictions in other curated data sources, including a manually curated, time-indexed reference standard of label change events. Results This method uses a classifier that achieves an area under the curve of 0.94 on a held out test set. The classifier is used on 2 362 950 possible drug–disorder pairs comprised of 1602 unique drugs and 1475 unique disorders for which we had data, resulting in 240 high-confidence, well-supported drug-AE associations. Eighty-seven of them (36%) are supported in at least one of the resources that have information that was not available to the classifier. Conclusion This method demonstrates the feasibility of systematic post-marketing surveillance for ADEs using electronic medical records, a key component of the learning healthcare system.

scholarly journals Gastrointestinal Adverse Events in Hospitalized Patients Following Orthopedic Surgery: Tapentadol Immediate Release Versus Oxycodone Immediate Release

2021 ◽  
pp. E309-E315
Author(s):  
Asad E. Patanwala
Keyword(s):  
Postoperative Pain ◽  
Electronic Medical Records ◽  
Orthopedic Surgery ◽  
Medical Records ◽  
Adverse Drug Events ◽  
Immediate Release ◽  
Orthopedic Procedures ◽  
Study Cohort ◽  
Tertiary Referral Hospital ◽  
Significant Difference

Background: Tapentadol has relatively less effect on μ-opioid receptors compared with other opioids. This has the potential to reduce the occurrence of gastrointestinal (GI) adverse drug events (ADEs). Objectives: To compare the GI ADEs during hospitalization between tapentadol immediate release (IR) and oxycodone IR following orthopedic surgeries. Study Design: Retrospective cohort study. Setting: A major metropolitan tertiary referral hospital in Australia. Methods: Data for adult orthopedic surgery patients receiving postoperative tapentadol IR or oxycodone IR during hospitalization between January 1, 2018 and June 30, 2019, were collected from electronic medical records. The primary outcome was the occurrence of postoperative GI ADEs occurring during hospitalization. This was defined as a composite of nausea, vomiting, or constipation. Results: The study cohort included 199 patients. Of these, 99 patients received tapentadol IR and 100 patients received oxycodone IR for postoperative pain during hospitalization. The mean age was 66 ± 12 years, and 111 patients (56%) were women. There was no significant difference between groups on the occurrence of GI ADEs (53% in oxycodone group and 51% in tapentadol group, difference 2%, 95% confidence interval [CI], –11% to 16%; P = 0.777). After adjusting for potential confounders, the use of tapentadol IR was not associated with a significant reduction of GI ADEs (odds ratio, 0.62; 95% CI, 0.32–1.20; P = 0.154). Limitations: This was a single-center study and should be extrapolated with caution. As this was a retrospective study, the accuracy and availability of data were dependent on documentation in electronic medical records. Conclusions: Tapentadol IR is associated with similar GI ADE occurrence compared with oxycodone IR in patients with orthopedic postoperative pain during hospitalization. Key words: Opioid analgesics, tapentadol, oxycodone, orthopedic procedures, postoperative pain, acute pain, gastrointestinal adverse drug events, opioid-induced adverse drug events

scholarly journals Restructuring service at a mastology outpatient clinic during the COVID-19 pandemic

2021 ◽  
Vol 74 (suppl 1) ◽  
Author(s):  
Cristina Poliana Rolim Saraiva dos Santos ◽  
Ana Fátima Carvalho Fernandes ◽  
Denise Montenegro da Silva ◽  
Régia Christina Moura Barbosa Castro
Keyword(s):  
Patient Safety ◽  
Electronic Medical Records ◽  
Outpatient Clinic ◽  
Medical Records ◽  
Healthcare Services ◽  
Public University ◽  
Telephone Contact ◽  
Health Team ◽  
Individual Assessment ◽  
Surgical Treatments

ABSTRACT Objective: to report the experience of a health team in restructuring service at a mastology outpatient clinic. Methods: an experience report in a public university service mastology outpatient in Ceará between March and April 2020. Service in this outpatient clinic is exclusively for women and who have breast changes for surgical treatments ranging from nodulectomies to mastectomies with oncoplastic. Results: increased COVID-19 cases brought the need to restructure healthcare services. The following steps were followed: identification of scheduled patients, reading of clinical developments in electronic medical records, individual assessment to define whether or not appointment would remain, telephone contact to inform about unscheduling. Among the 555 consultations scheduled for March and April 2020, 316 (56.9%) were maintained. Final considerations: restructuring consultations at a mastology outpatient clinic optimized the waiting time for consultations and avoided crowds at service, providing patient safety.

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