CardioExchange Archive

CardioExchange, an NEJM practice community for medical professionals dedicated to improving cardiac patient care, was active from 2009 to 2015. CardioExchange fostered discussion between clinicians from across the globe.

December 18th, 2009

Avoiding Wrong Meds in Dialysis Patients Having PCI: The Expert’s Recommendations

According to a recent study, almost one-fourth of dialysis patients undergoing PCI receive an antithrombotic agent (enoxaparin or eptifibatide) that is contraindicated in individuals with renal disease, resulting in excessive major bleeding and death. 

In a CardioExchange blog, the study’s lead author notes that this error was more likely to occur in hospitals that were rural or non-teaching or that had lower procedural volumes.  He recommends (a) using EMR to avoid this and (b) providing safety seminars in residency/fellowship training programs.

Will such strategies be effective in the hospital settings where this error is most likely to occur?

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2 Responses to “Avoiding Wrong Meds in Dialysis Patients Having PCI: The Expert’s Recommendations”

  1. Ellen Keeley, MD, MS says:
    December 23, 2009 at 2:37 pm

    I agree that electronic medical records may help by flagging medications that should not be prescribed for an individual patient, and focused teaching of trainees is critical. Perhaps another way to decrease the chance that these medications are administered to dialysis patients is to require that with the order a creatinine value (or creatinine clearance value) must also be provided to the pharmacy (or the Pixis if in the cath lab). This way the medication will only be dispensed if the renal function is within a certain range of values. Only 6.5% of the patients in the study underwent PCI emergently for STEMI; more than 93% were elective or semi-elective, thus giving ample time to provide a creatinine value and preventing the administration of these medications to the vast majority of dialysis patients.

  2. Richard A. Lange, MD, MBA says:
    January 5, 2010 at 10:21 am

    EMR Limitations

    Ellen, I agree that EMR can help decrease medication errors. Unfortunately, less than 10% of hospitals have an EMR. Since the medication errors noted in the study were more likely to occur in rural, non teaching hospitals (i.e., institutions that are the less likely to have an EMR), I’m concerned that an EMR solution won’t be effective.