Sharma Munish, Krishnamurthy Mahesh, Snyder Richard, Mauro James
Department of Internal Medicine, Easton Hospital, Easton, PA, USA.
Department of Nephrology, Easton Hospital, Easton, PA, USA.
Clin Pract. 2017 Apr 20;7(2):953. doi: 10.4081/cp.2017.953. eCollection 2017 Apr 6.
The incorporation of a clinical pharmacist in daily rounding can help identify and correct errors related to anticoagulation dosing. Inappropriate anticoagulant dosing increases the risk of developing significant bleeding diathesis. Conversely, inappropriate dosing may also fail to produce a therapeutic response. We retrospectively reviewed electronic medical records of 41 patients to confirm and analyze the errors related to various anticoagulants. A clinical pharmacist in an integrated rounding between the period of February 2016 and April 2016 collected this data. We concluded that integrated rounding improves patient safety by recognizing anticoagulant dosage error used for the purpose of prophylaxis or treatment. It also allows us to make dose adjustments based on renal function of the patient. We think that it is prudent for physicians to pay particular attention to creatinine clearance when dosing anticoagulants in order to achieve the intended dosing effect and reduce the risk of adverse drug events.
临床药师参与日常查房有助于识别和纠正与抗凝药物剂量相关的错误。抗凝药物剂量不当会增加发生严重出血素质的风险。相反，剂量不当也可能无法产生治疗效果。我们回顾性分析了41例患者的电子病历，以确认和分析与各种抗凝药物相关的错误。一名临床药师在2016年2月至2016年4月期间的联合查房中收集了这些数据。我们得出结论，联合查房通过识别用于预防或治疗目的的抗凝药物剂量错误提高了患者安全性。它还使我们能够根据患者的肾功能进行剂量调整。我们认为，医生在使用抗凝药物时特别关注肌酐清除率是谨慎的做法，以便达到预期的给药效果并降低药物不良事件的风险。
