Case 1 (An Endogenous Error)
An endogenous error arises solely from within an individual, from a random and unpredictable cognitive event such as miscalculating a dose or prescribing a drug at a dose appropriate for the next medication being contemplated.
Case 1
A physician ordered a heparin infusion with directions to follow a weight-based nomogram for laboratory monitoring and dose adjustments. Later that evening, the nomogram indicated that an intravenous (IV) bolus dose of heparin 1,700 units should be administered based on the patient’s activated partial thromboplastin time (aPTT) level.
I ike it or not, part of our national lexicon includes the phrase “How you doin’,” often attributed to denizens of our beloved city of the founding fathers, namely, Philadelphia. I thought about how we’re doin’ when I had an opportunity to review the annual report of the Agency for Healthcare Research and Quality (AHRQ) on the state of health care quality in our nation.
A new Medicaid rule has retail pharmacies worried that lower reimbursements for popular generic drugs might cause their profits—and their business—to disappear. But the pharmacies had better not hold their breath as they wait for Congress to come to their rescue.
Published on July 6, 2007, the new rule essentially implements a congressional law in 2006 that requires Medicaid to adjust how the average manufacturer’s price (AMP) is calculated; the AMP, in turn, determines a state’s reimbursement to pharmacies. This ruling affects only generic drugs, not brand-name products. The federal government reimburses the states for patients’ drug expenditures according to an impossibly confusing formula built around a concept called “federal upper limits.” The formula, consequently, depends on the AMP.
Problem: Over the years, numerous cases of confusion between methylpred-nisolone acetate (Depo-Medrol) and methylprednisolone sodium succinate (Solu-Medrol) have been reported. Although both forms of the product are used to treat inflammation, dosing may differ. The acetate form should never be given by intravenous (IV) administration.
I am confident that readers of P&T struggle with the critical issue of medication adherence on a regular basis. I am also sure that most of us are frustrated by our feeble attempts to improve low rates of patient compliance, especially with medications needed for chronic conditions. I am always on the lookout for help in this area. An article in the Archives of
Internal Medicine might just shed some light on our collective conundru m. Researchers at Emory University School of Medicine in Atlanta and at McMaster University in Hamilton, Ontario, Canada, completed an incredible piece of scholarship: they reviewed every randomized controlled trial published from January 1967 to September 2004. The articles covered interventions that were intended to enhance adherence to therapy with self-administered medications to treat chronic medical conditions. Allow me to set the stage for this study, outline the key components, and comment on their findings.
All physicians agree that change is inevitable in the practice of medicine. Practicing Medicine in the 21st Century is targeted toward medical students, residents, and physicians in a variety of settings. As a practicing physician for over 25 years, I predict that this book will be extremely useful for physicians of all ages and at all stages of their professional careers.
