American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists
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Am J Health Syst Pharm · Nov 2001
Achievement of anticoagulation by using a weight-based heparin dosing protocol for obese and nonobese patients.
The need for different heparin dosing protocols for obese and nonobese patients was studied. A chart review was performed for all patients who received heparin over an eight-month period at an acute care hospital. Data collected included age, sex, height, actual body weight (ABW), ideal body weight (IBW), initial activated partial thromboplastin time (aPTT), initial heparin bolus dose, initial heparin i.v. infusion rate, time to initial targeted aPTT, and final infusion rate. ⋯ Times to targeted aPTT for obese and nonobese patients were 25.86+/-12.83 and 25.18+/-14.76 hours, respectively; mean final infusion rates were 12.94+/-2.56 and 12.36+/-2.54 units/kg/hr; and percent changes from initial to final infusion rates were 11.84% and 17.76%. There were no significant differences in initial or final infusion rates or time to targeted aPTT between the two groups. It is appropriate to use ABW in a weight-based heparin dosing protocol for obese patients.
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The problem of medical errors associated with the naming, labeling, and packaging of pharmaceuticals is discussed. Sound-alike and look-alike drug names and packages can lead pharmacists and nurses to unintended interchanges of drugs that can result in patient injury or death. The existing medication-use system is flawed because its safety depends on human perfection. ⋯ Although a variety of private-sector organizations have called for reforms in drug naming, labeling, and packaging standards have been proposed, the problem remains. Drug names, labels, and packages are not selected and designed in accordance with human factors principles. FDA standards do not require application of these principles, the drug industry has struggled with change, and private-sector initiatives have had only limited success.
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Am J Health Syst Pharm · Nov 2001
ReviewVenous thromboembolism following major orthopedic surgery: review of epidemiology and economics.
The epidemiology and economics of venous thromboembolism (VTE) associated with hip and knee arthroplasty and surgical repair of hip fracture are reviewed. In the 1960s and 1970s, prior to the widespread use of prophylaxis, the risk of VTE following major orthopedic surgery was substantial. The risk of fatal pulmonary embolism (PE) following hip fracture repair may have been as high as 7.5%. ⋯ The cost of VTE after major orthopedic surgery includes initial therapy (the chief component), follow-up care, and the expected costs of major hemorrhage (due to anticoagulation), recurrent VTE, and postthrombotic syndrome. The total cost per patient of such care is approximately $11,600. The risk of VTE after surgery to replace hip and knee joints and repair hip fracture is far lower today than in the 1960s and 1970s, but the cost of treating VTE remains high: an estimated $11,600 per patient, including hospitalization costs.