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Preventing Medication Errors
Acute Coronary Syndromes
The committee reviewed seven studies on quality of care for acute myocardial infarction. Six of these studies determined prescription rates for indicated medications at discharge (Alexander et al., 1998; Petersen et al., 2001; Krumholz et al., 2003; Petersen et al., 2003; Roe et al., 2005; Granger et al., 2005). For patients discharged with a diagnosis of acute myocardial infarction, aspirin was prescribed to 53 to 93.4 percent of ideal candidates (those with no known contraindication). Beta-blockers were prescribed to 53 to 83.4 percent of ideal candidates, and angiotensin converting enzyme (ACE) inhibitors to 58.5 to 83.4 percent of ideal candidates. Three studies described rates of aspirin and beta-blocker use within the first 24 hours of hospitalization (Sanborn et al., 2004; Roe et al., 2005; Granger et al., 2005). Within the first 24 hours of hospitalization for a myocardial infarction, 66 to 78 percent of patients had received beta-blockers and 84.9 to 93 percent aspirin.
The committee identified six studies that described rates of antibiotic prophylaxis for surgical procedures (Heineck et al., 1999; Vaisbrud et al., 1999; van Kasteren et al., 2003; Gupta et al., 2003; Bedouch et al., 2004; Quenon et al., 2004). Rates of antibiotic prophylaxis ranged from 70 to 98 percent within the surgical studies. Although the rates of prescribing any antibiotic were high, antibiotic prophylaxis for surgical procedures requires that the appropriate antibiotic be selected, that the appropriate dose be prescribed, that the drug be administered at the appropriate time, and that the duration of therapy be correct. Absolute compliance with all of these elements of drug therapy was much lower—as low 3 percent in one study (Gupta et al., 2003).
The committee identified nine studies that determined rates of thromboembolic prophylaxis in at-risk hospitalized patients (Campbell et al., 2001; Ageno et al., 2002; Ahmad et al., 2002; Aujesky et al., 2002; Freeman et al., 2002; Learhinan and Alderman, 2003; Scott et al., 2003; Tan and Tan, 2004; Chopard et al., 2005). Thromboembolic prophylaxis includes both mechanical means, such as lower-extremity compression hose, and pharmacological means, such as subcutaneous heparin. Because medications are recommended in individuals at high risk for thrombosis, the committee included these studies.