Medication safety improves after implementation of positive patient identification.

OBJECTIVE: To report the incidence and severity of medication safety events before and after initiation of barcode scanning for positive patient identification (PPID) in a large teaching hospital. METHODS: Retrospective analysis of data from an existing safety reporting system with anonymous and non-punitive self-reporting. Medication safety events were categorized as "near-miss" (unsafe conditions or caught before reaching the patient) or reaching the patient, with requisite additional monitoring or treatment. Baseline and post-PPID implementation data on events per 1,000,000 drug administrations were compared by chi-square with p<0.05 considered significant. RESULTS: An average of 510,541 doses were dispensed each month in 2008. Total self-reported medication errors initially increased from 20 per million doses dispensed pre-barcoding (first quarter 2008) to 38 per million doses dispensed immediately post-intervention (last quarter 2008), but errors reaching the patient decreased from 3.26 per million to 0.8 per million despite the increase in "near-misses". A number of process issues were identified and improved, including additional training and equipment, instituting ParX scanning when filling Pyxis machines, and lobbying for a manufacturing change in how bar codes were printed on bags of intravenous solutions to reduce scanning failures. CONCLUSION: Introduction of barcoding of medications and patient wristbands reduced serious medication dispensing errors reaching the patient, but temporarily increased the number of "near-miss" situations reported. Overall patient safety improved with the barcoding and positive patient identification initiative. These results have been sustained during the 18 months following full implementation.

Palliative care and HIV, part II: systemic manifestations and late-stage issues.

AIDS: The last stages of HIV infection are marked by increasing pain, gastrointestinal discomfort, and depression. These conditions should be treated aggressively with restorative and prophylactic therapies. Patients who are bedridden or are suffering from an inflammatory or infiltrative process may suffer from somatic or visceral pain, which can be treated with analgesics. Patients with chronic pain and a history of narcotic abuse are not likely to develop addictions to opiates, and narcotics can be prescribed. Meanwhile, neuropathic pain, characterized as burning and tingling, is treated with tricyclic antidepressants and antiepileptic drugs. Also, depression, which affects up to 30 percent of HIV-positive patients, should be treated with the selective serotonin reuptake inhibitors. As a patient approaches death, talking with the patient, providing physical contact, and encouraging spiritual reflection can be beneficial. Current hospice care for AIDS patients needs to be improved, and palliation of the HIV disease should be predicated on patient preference, ease of administration, and minimization of side effects.^ieng

Palliative care and HIV, part I: OIs and cancers.

AIDS: A two-part report discusses palliative care for opportunistic infections and cancers of HIV-infected people, and addresses systemic manifestations. Guidelines are provided for determining when palliation with traditional methods is best achieved, and when continuation of restorative treatments is an appropriate palliative measure. Pneumocystis carinii pneumonia, cryptococcal meningitis, Cytomegalovirus retinitis, and Mycobacterium avium complex palliative care are examined. The HIV-related cancers, Kaposi's sarcoma and primary central nervous system lymphoma, are also examined.^ieng

A method for the quantitation of hypericin, an antiviral agent, in biological fluids by high-performance liquid chromatography.

Hypericin, a polycyclic aromatic dianthroquinone, is a natural plant product with antiviral properties. We report here the development of a methodology for the extraction and quantitation of hypericin from plasma and biological fluids and the adaptation of a sensitive and selective method for detection of the compound by high-performance liquid chromatography. The methodology offers a rapid and specific means of monitoring drug blood levels in clinical and pharmacokinetic studies. The chromatographic procedure utilizes the substantial retentive properties of hypericin on reverse-phase media and detection by the strong visible absorbance maximum at 590 nm. Verification by the fluorescence spectral properties of hypericin in organic media can also be utilized. The assay is linear over a 3 log concentration range and hypericin is consistently recovered from murine, simian, and human plasma. The methodology was applied to assess the pharmacokinetic properties of hypericin in mice receiving a single bolus injection of 350 micrograms. A distribution half-life of 2.0 h and an elimination half-life of 38.5 h were calculated. We also discuss the limitations of direct analysis of hypericin by absorbance or fluorescence measurements.