ORIGINAL ARTICLEMedication Errors in Patients With Severe Chronic Kidney Disease and Acute Coronary Syndrome: The Impact of Computer-Assisted Decision Support
Section snippets
PATIENTS AND METHODS
We recorded clinical characteristics, hospital length of stay, 90-day mortality, and in-hospital bleeding in 80 consecutive ACS patients with severe CKD admitted to the Ochsner Foundation Hospital from January 1, 2009, to December 31, 2010, without a palliative care designation.
These patients constituted 6.4% of all ACS admissions during that period. The admitting physician (the house officer on duty, whose role was limited to day of admission) had the choice of using preprinted paper orders
RESULTS
The mean ± SD age of the 80 patients admitted with ACS was 70±14 years; 60% were male. The mean glomerular filtration rate was 14.5±7.9 mL/min/1.73 m2, and 14 patients (18%) were undergoing dialysis. Unstable angina was diagnosed in 11 patients (14%), non-ST-segment elevation myocardial infarction in 60 (75%), and ST-segment elevation myocardial infarction in 9 (11%). The mean TIMI risk score was 3.8±1.6 (range, 1-9), and the mean bleeding risk score was 59±9 (range, 33-82). Forty (50%) of the
DISCUSSION
The current investigation has 2 key findings. First, prescribing contraindicated antithrombotic medications is not infrequent in patients with severe CKD admitted with ACS, occurring in 10% of our cohort, and is associated with a 6-fold increased risk of in-hospital bleeding. Second, CPOE with decision support is an effective tool in reducing the frequency of medication errors in this population.
Since 2000, when the Institute of Medicine (IOM) issued its report “To Err Is Human: Building a
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Presented in part at the American College of Cardiology (ACC.11/i2) Summit, New Orleans, LA, April 2011.