ABSTRACT
Purpose: Our aim was to inform a new definition of wrong-patient errors, obtained through an analysis of incident reports related to medication errors. Methods: We investigated wrong-patient medication errors in incident reports voluntarily reported by medical staff using a web-based incident reporting system from 2015 to 2016 at a university hospital in Japan. Incident report content was separately evaluated by four evaluators using investigational methods for clinical incidents from the Clinical Risk Unit and the Association of Litigation and Risk Management. They investigated whether it was the patient or drug that was incorrectly chosen during wrong-patient errors in drug administration in incident reports and assessed contributory factors which affected the error occurrence. The evaluators integrated the results and interpreted them together. Results: Out of a total 4337 IRs, only 30 cases (2%) contained wrong-patient errors in medication administration. The cases where the intended drugs were administered to incorrect patients occurred less frequently than cases where the wrong drugs were administered to the intended patients through the investigation of wrong targets. After a discussion, the evaluators concluded that the patient - drug/CPOE screen mismatch, caused by choosing the wrong patient, drug, or CPOE screen (mix-ups), occurred in the wrong-patient medication errors. These errors were caused by three conditions: (1) where two patients/drugs were listed next to one another, (2) where two patients' last names/drugs' names were the same, and (3) where the patient/drug/CPOE screen in front of the staff involved was believed to be the correct one. Additionally, these errors also involved insufficient confirmation, which led to failure to detect and correct the mismatch occurrences. Conclusion: Based on our study, we propose a new definition of wrong-patient medication errors: they consisted of choosing a wrong target and insufficient confirmation. We will investigate other types of wrong-patient errors to apply this definition.
ABSTRACT
BACKGROUND: Taxanes are known to cause onychopathy. Previous studies have reported the relationship between onychopathy and paclitaxel dosing intervals and cumulative doses. However, there are no studies of the predictive factors for docetaxel-induced nail changes. The present study used the drug accumulation rate (mg/m2/day) as a novel indicator and evaluated its usefulness for the prediction of onychopathy. METHODS: From January 2008 to December 2009, we examined patients who received docetaxel at the Toyama University Hospital and Tonami General Hospital to determine the time to onset of onychopathy, the accumulation rate, and the cumulative dose. We then divided the study subjects into two groups, and used Receiver Operating Characteristic (ROC) analysis to calculate a cut-off value. We evaluated both indicators as predictive factors for onychopathy using the log-rank test and Cox proportional hazards model. RESULTS: Ninety-five patients were included in the present study. The results of the log-rank test sub-analysis revealed that the median number of days until onychopathy onset was significantly shorter in patients with an accumulation rate greater than the cut-off (P = 0.009), and in those with a cumulative dose below the cut-off (P < 0.001). The hazard ratios for the accumulation rate and cumulative dose, evaluated using Cox proportional hazards regression analysis, were 1.44 (P = 0.036) and 0.99 (P < 0.001), respectively. CONCLUSIONS: The results of the present study indicated that the drug accumulation rate influenced the time to onset of docetaxel-induced onychopathy. TRIAL REGISTRATION: This study is not applicable for trial registration due to retrospective chart review without intervention.
ABSTRACT
The adsorption of Bevacizumab, Trastuzumab, Rituximab, Nedaplatin, Vincristine sulfate, Nogitecan hydrochloride, Actinomycin D and Ramosetron hydrochloride to 0.2 µm endotoxin-retentive in-line filters was evaluated with pediatric doses by UV spectrophotometry. The results indicated that some drug adsorption was shown with Nogitecan hydrochloride, Actinomycin D and Ramosetron hydrochloride, and good recovery was shown with the other five drugs. For the three drugs which showed some losses, drug recovery was investigated at multiple test doses. The approximation formula for each drug adsorption was recorded as Y=100-A/X (X: dose (mg), Y: recovery rate (%), A: a constant for individual drug). The results showed there was high correlation between the reciprocal of test drug dose and the recovery rate. Furthermore, in the cases where adsorption to the filter were observed, it was found that it was possible to determine the relationship between dose and the recovery rate from a filterability test with one point pediatric dose. Since the recovery rate obtained from the approximation formula with multiple doses and that calculated from the prediction formula with one point pediatric dose were almost the same, then it was concluded that it is not necessary to conduct the filterability tests with multiple doses. We have shown that using UV spectrophotometry and carrying out a filterability test using one point pediatric dose is relatively easy method and reduces the effort and expense. This method for analysis of drug adsorption is extremely useful when using in-line filters with infusion therapy.
Subject(s)
Spectrophotometry, Ultraviolet/methods , Drug Dosage Calculations , FiltrationABSTRACT
Morphine is the dominant medication to control cancer pain. Morphine consumption has been increasing each year in many countries including Japan based on the understanding of the WHO report on the treatment of cancer pain. To evaluate the recent and current state of palliative medication for cancer patients in Toyama Medical and Pharmaceutical University (TMPU) Hospital, the amount of and trend in the use of morphine preparations from 1992 to 2001 were investigated. The amount used increased every year to 3.9-fold of that in 1992 at the end of this survey. In particular, the consumption of morphine sulfate sustained-release tablets and morphine hydrochloride injection increased markedly, because both total dose in individual patients and the number of patients treated with high-dose morphine increased. The distribution of the maximum daily dose in TMPU Hospital was similar to that in a specialist hospital in oncology. In conclusion, morphine consumption will increase to achieve better palliative care and to improve quality of life in cancer patients, and therefore appropriate use and regulation of narcotic preparations are necessary.
