Pharmacists detect more errors at admission, says British study
Pharmacists taking a patient’s medication history on admission can cut prescribing errors, according to a study released by the British Pharmaceutical Conference in Manchester.
The study aimed to investigate the types and frequencies of prescribing errors at different stages during patients’ admissions to hospital, and whether pharmacists identified more or different prescribing errors on admission than at other times. The study was carried out jointly by the School of Pharmacy and Pharmaceutical Sciences at the University of Manchester, Hope Hospital in Salford, and the Evidence for Population Health Unit at the University of Manchester.
Pharmacists reviewed 33,012 prescriptions for 5,199 patients at varying times of admission; during the hospital stay, on rewritten charts, and on discharge prescriptions. The results found that 3,463 prescriptions contained an error. The chance of an error being identified was greater in those written at the time of the patient’s admission:
- On admission: 14.5%
- During the stay: 12.3%
- On rewritten charts: 7.8%
- On discharge: 11.1%
The most common type of errors included:
- Need for the drug: 37%
- Selection of specific drug: 3.5%
- Selection of dose: 26%
- Administration instructions for drug: 22%
- Instructions for provision of drug: 12%.
Government issues regulations that support e-prescribing
The Centers for Medicare & Medicaid Services (CMS) and the Office of Inspector General (OIG) have announced new proposals that would allow hospitals and certain health care organizations to furnish hardware, software, and related training services to physicians for e-prescribing and electronic health records, particularly when the support involves systems that are "interoperable."
One proposal would establish the conditions under which hospitals and certain other entities can give physicians hardware, software, or information technology, and training services for e-prescribing. The second proposal would establish the conditions under which such entities may donate to physicians electronic health records software and related training services.
CMS will soon issue a final rule containing the "foundation standards" for e-prescribing that all Medicare prescription drug plans must support. Comments submitted in response to a proposed rule showed adequate industry experience to implement standards when the Medicare drug benefit begins in January 2006.
As part of the support to establish high-quality, efficient e-prescribing systems, $6 million is being awarded by CMS to fund e-prescribing pilot programs using the foundation standards and additional clinical standards, as required by the Medicare Modernization Act of 2003.
Pharmacist-physician team to test bar code scanning in NICU
A physician-pharmacist research team has received funding to study the effectiveness of using a medication bar code scanning system to reduce the occurrence of medication errors in a neonatal intensive care unit.
The team will institute a complete medication bar code system in the University of Iowa Hospital and Clinics’ Neonatal Intensive Care Unit (NICU). In this new system, medications will be dispensed by a robot that affixes a bar code to a unit dose. When the dose is delivered to the NICU, the caregiver will scan the medication dose bar code and the patient’s bar coded identification band. An integrated computer will use this information to check the medication against the medication order as well as other pertinent patient information, such as weight. When the computer has determined that the medication is the correct drug and dose, the patient is the right patient, the time is correct, and there are no contraindications, it will then signal that the medication may be given to the patient. The computer will also electronically record the administration of the medication in the patient’s medication administration record.
The study, funded by a research grant from the American Society of Health-System Pharmacists Research and Education Foundation in Bethesda, MD, will be conducted for 14 months. Results are expected in early 2007.
FDA recalls injectable products manufactured by CAPS
The FDA is notifying health care professionals and hospitals about a product recall involving all injectable products manufactured by Central Admixture Pharmacy Services (CAPS) of Lanham, MD, due to concerns regarding the sterility of these injectable products. CAPS distributed the affected injectable products to hospitals in Maryland; Delaware; Washington, DC; and Virginia. Gram-negative rods have been identified in two lots of Cardioplegia solution manufactured by CAPS. Nonsterility of injectable products could represent a serious hazard to health that could lead to life-threatening injuries and death.
Although CAPS has directly notified known hospital customers of the recall, hospitals, physicians, and health care workers are urged to examine their supplies for any CAPS of Lanham, MD, injectable products and immediately discontinue their use and quarantine the products. For the list of products distributed up to Sept. 16 that are affected by this action, see www.fda.gov/medwatch/safety/2005/safety05.htm#CAPS.
HHS announces medications purchase for influenza outbreak
The Department of Health and Human Services (HHS) has announced the purchase of vaccine and antiviral medications that could be used in the event of a potential influenza pandemic.
The department has awarded a $100 million contract to Sanofi Pasteur to manufacture avian influenza vaccine designed to protect against the H5N1 influenza virus strain, which has caused an epidemic of avian flu in Asia. The number of individuals who could be protected by the newly contracted vaccine still is to be determined by ongoing clinical studies. In addition, HHS has awarded a $2.8 million contract to GlaxoSmithKline for 84,300 treatment courses of the antiviral drug zanamivir (Relenza).
These purchases build on HHS’ plans to buy enough vaccine for 20 million people and enough antivirals for another 20 million people. These supplies of vaccine and antiviral treatment will be placed in the nation’s Strategic National Stockpile where they will be available for use should an influenza pandemic occur.
Confusion reported between Toprol-XL, topiramate (Topamax)
AstraZeneca and the FDA have notified health care professionals of reports of medication dispensing or prescribing errors between metoprolol succinate (Toprol-XL) extended release tablets — indicated for the treatment of hypertension, long-term treatment of angina pectoris, and heart failure NYHA Class II or III — and topiramate (Topamax), a product of Ortho-McNeil Neurologics — indicated for the treatment of epilepsy and migraine prophylaxis.
There also have been reports of medication errors involving confusion between Toprol-XL and Tegretol or carbamazepine (Tegretol-XR), products of Novartis Pharmaceuticals Corp., indicated for the treatment of complex partial seizures, generalized tonic-clonic seizures, and trigeminal neuralgia. These reports include instances where Toprol-XL was incorrectly administered to patients instead of Topamax, Tegretol, or Tegretol-XR, and vice versa, some of them leading to adverse events.
For more information, see www.fda.gov/medwatch/safety/2005/safety05.htm#Toprol.
Sanofi Pasteur warns of vaccine adverse effects
Sanofi Pasteur has been notified of five reports through the Vaccine Adverse Event Reporting System (VAERS) of Guillain-Barre syndrome (GBS) following administration of meningococcal vaccine (Menactra).
In response to these reports, Sanofi Pasteur is contacting all customers who have received shipments of the vaccine to inform them of these reports and to remind them of the importance of reporting vaccine adverse events.
More than 2.5 million doses of the meningococcal vaccine have been distributed and the rate of GBS based on the number of cases reported following administration is in the range that might be seen, regardless of vaccination, in a population of that size.
No causal relationship has been established between the vaccination and GBS, and several possible explanations for the reported cases of GBS remain.
Pharmacists taking a patients medication history on admission can cut prescribing errors, according to a study released by the British Pharmaceutical Conference in Manchester.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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