Victor O Popoola1, Brandyn D Lau2,3, Esther Tan1, Dauryne L Shaffer4, Peggy S Kraus5, Norma E Farrow1, Deborah B Hobson4, Jonathan K Aboagye1,6, Michael B Streiff7, Elliott R Haut8,9,10. 1. Division of Acute Care Surgery, Department of Surgery, Johns Hopkins Hospital, Baltimore, MD. 2. Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Hospital, Baltimore, MD. 3. Division of Health Sciences Informatics, Johns Hopkins School of Medicine, Baltimore, MD. 4. Department of Nursing, Johns Hopkins Hospital, Baltimore, MD. 5. Department of Pharmacy, Johns Hopkins Hospital, Baltimore, MD. 6. Armstrong Institute for Patient Safety and Quality, Johns Hopkins Medicine, Baltimore, MD. 7. Division of Hematology, Department of Medicine, Johns Hopkins Hospital, Baltimore, MD. 8. Division of Acute Care Surgery, Department of Surgery, Johns Hopkins Hospital, Baltimore, MD ehaut1@jhmi.edu. 9. Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD ehaut1@jhmi.edu. 10. Armstrong Institute for Patient Safety and Quality, Johns Hopkins Medicine, Baltimore, MD ehaut1@jhmi.edu.
Abstract
PURPOSE: Results of a study to characterize patterns of nonadministration of medication doses for venous thromboembolism (VTE) prevention among hospitalized patients are presented. METHODS: The electronic records of all patients admitted to 4 floors of a medical center during a 1-month period were examined to identify patients whose records indicated at least 1 nonadministered dose of medication for VTE prophylaxis. Proportions of nonadministered doses by medication type, intended route of administration, and VTE risk categorization were compared; reasons for nonadministration were evaluated. RESULTS: Overall, 12.7% of all medication doses prescribed to patients in the study cohort (n = 75) during the study period (857 of 6,758 doses in total) were not administered. Nonadministration of 1 or more doses of VTE prophylaxis medication was nearly twice as likely for subcutaneous anticoagulants than for all other medication types (231 of 1,112 doses [20.8%] versus 626 of 5,646 doses [11.2%], p < 0.001). For all medications prescribed, the most common reason for nonadministration was patient refusal (559 of 857 doses [65.2%]); the refusal rate was higher for subcutaneous anticoagulants than for all other medication categories (82.7% versus 58.8%, p < 0.001). Doses of antiretrovirals, immunosuppressives, antihypertensives, psychiatric medications, analgesics, and antiepileptics were less commonly missed than doses of electrolytes, vitamins, and gastrointestinal medications. CONCLUSION: Scheduled doses of subcutaneous anticoagulants for hospitalized patients were more likely to be missed than doses of all other medication types.
PURPOSE: Results of a study to characterize patterns of nonadministration of medication doses for venous thromboembolism (VTE) prevention among hospitalized patients are presented. METHODS: The electronic records of all patients admitted to 4 floors of a medical center during a 1-month period were examined to identify patients whose records indicated at least 1 nonadministered dose of medication for VTE prophylaxis. Proportions of nonadministered doses by medication type, intended route of administration, and VTE risk categorization were compared; reasons for nonadministration were evaluated. RESULTS: Overall, 12.7% of all medication doses prescribed to patients in the study cohort (n = 75) during the study period (857 of 6,758 doses in total) were not administered. Nonadministration of 1 or more doses of VTE prophylaxis medication was nearly twice as likely for subcutaneous anticoagulants than for all other medication types (231 of 1,112 doses [20.8%] versus 626 of 5,646 doses [11.2%], p < 0.001). For all medications prescribed, the most common reason for nonadministration was patient refusal (559 of 857 doses [65.2%]); the refusal rate was higher for subcutaneous anticoagulants than for all other medication categories (82.7% versus 58.8%, p < 0.001). Doses of antiretrovirals, immunosuppressives, antihypertensives, psychiatric medications, analgesics, and antiepileptics were less commonly missed than doses of electrolytes, vitamins, and gastrointestinal medications. CONCLUSION: Scheduled doses of subcutaneous anticoagulants for hospitalized patients were more likely to be missed than doses of all other medication types.
Authors: Holly Guy; Vicki Laskier; Mark Fisher; W Richey Neuman; Iwona Bucior; Steven Deitelzweig; Alexander T Cohen Journal: Pharmacoeconomics Date: 2019-05 Impact factor: 4.981
Authors: Oluwafemi P Owodunni; Brandyn D Lau; Michael B Streiff; Peggy S Kraus; Deborah B Hobson; Dauryne L Shaffer; Kristen L W Webster; Mujan Varasteh Kia; Christine G Holzmueller; Elliott R Haut Journal: Blood Adv Date: 2019-02-26
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Authors: Christopher J Pannucci; Kory I Fleming; Thomas K Varghese; John Stringham; Lyen C Huang; T Bartley Pickron; Ann Marie Prazak; Corinne Bertolaccini; Arash Momeni Journal: Ann Surg Date: 2020-10-19 Impact factor: 12.969