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Medication Related Problems in Dialysis Patients: Errors within the U.S. Healthcare System

In the United States healthcare system, medication-related problems (MRP) lead to alarming patient morbidity, mortality, and cost. MRP are implicated in 16.1% of internal medicine ward hospital admissions. 58.9% of admissions could definitely or possibly be avoided. Once admitted to the internal medicine ward, greater than 18% of patient deaths can be attributed to one or more drugs. Annually, adverse drug events contribute to over 100,000 deaths. The economic repercussion of MRP on the healthcare system is estimated to be in excess of $177 billion.

The provision of pharmaceutical care can aide in identifying and resolving MRPs, especially in dialysis patients. Pharmaceutical care is a practice in which a pharmacist takes the responsibility for the patient’s drug related needs, and is held accountable for their commitment. Pharmaceutical care has made substantial contributions to patient morbidity and mortality in dialysis and congestive heart failure patients.

Medication Related Problems In Dialysis Patients Include:

  • Indication without drug therapy
  • Subtherapeutic dosages
  • Adverse drug reactions
  • Failure to Receive Drugs
  • Drugs without Indication
  • Improper Drug Selection
  • Overdosage
  • Drug Interaction
  • Inappropriate laboratory monitoring

The Most Common MRPS are:

  • Inappropriate laboratory monitoring (23.5%)
  • Indication without drug therapy (16.9%)
  • Dosing errors accounted for 20.4% of medication-related problems
    • Subtherapeutic dosage: (11.2%)
    • Overdosage: (9.2%)

Nurses cannot generate medication orders, because they do not have a background in medication therapy and all too often are too busy. Pharmacists can help the nursing staff with medication management because Pharmacists are uniquely trained to detect and manage medication related problems. All pharmacists trained in the U.S. graduate with over six years of training. Pharmacists involved in dialysis enable nurses to better care for ESRD patients. Just observing dialysis unit pharmacists teaches nurses about medication management and dosing. Unheard of twenty years ago, many hospitals across the nation are starting to realize that having a pharmacist dedicated to end stage renal disease patients has many benefits. Some states, such as Florida, require dialysis centers to have a pharmacist on staff. New Jersey even requires the pharmacists in their centers to review procedures, offer educational programs, review medical records, and submit quarterly reports.

Pharmacists on staff are part of the recent attempts to resolve medication related problems in dialysis patients, but errors still occur frequently. For example, on March 29, 2012 the FDA issued a Class 1 recall, the agency’s highest level of recall on GranuFlo Dry Acid Concentrate and NaturaLyte Liquid Acid Concentrate. Patients who have received improper doses of these medications, administered to replace amino acids lost during the hemodialysis procedure, have suffered potentially deadly reactions

According to the FDA, if GranuFlo and NaturaLyte are administered improperly, they contribute to elevated bicarbonate levels in dialysis patients. This can cause metabolic alkalosis, a pH imbalance in which the body has accumulated too much of an alkaline substance. Metabolic alkalosis is considered a risk factor for several serious conditions, such as:

  • Cardiac arrhythmia (irregular heart rate)
  • Cardiopulmonary arrest (heart attack)
  • Hypotension (low blood pressure)
  • Hypoxemia (low blood oxygen)
  • Hypercapnia (increased carbon dioxide in the blood)
  • Hypokalemia (low potassium levels in the blood)

Even with pharmacists on staff and the removal of GranuFlo and NaturaLyte, medication related problems in dialysis patients persist. Thomas T. Tsai, MD, director of interventional cardiology at Denver VA Medical Center, told Cardiovascular Business News that studies show a large problem of medication administration errors in the U.S., and he calls for better IT tools to warn physicians about contraindicated medications. He explained that health IT tools need to do a better job of alerting physicians when they have improperly ordered medication with such systems as a computerized provider order entry (CPOE). Such IT systems can ask providers questions about the patient. “Is this patient on dialysis or does the patient have impaired renal function? With these answers, the system tells whether or not certain medications can or can’t be prescribed. Dr. Tsai explained that in the cath lab, 60 combinations of medications and more than 1,000 different permutations can be configured for each patient. With dialysis patients on so many medications, the field is ripe for errors and omissions.

Our lawyers investigate to discover whether or not you were misdiagnosed or suffered as the result of one of the many medication related problems that can occur with dialysis. If you know or suspect that you were dosed incorrectly as part of your dialysis therapy, please let us know when you contact us for a free legal evaluation as this information will be helpful in your dialysis lawsuit process.

Family members of individuals who suffered complications, including loss of life, as a result of a medication related problem with dialysis may also be eligible to file a lawsuit on behalf of their loved one. If you lost a family member as a result of improper medication dosages during dialysis, you have our deepest sympathies. We would be happy to discuss your potential lawsuit with you. Contact one of our experienced attorneys at Dolman Law Group today at (727) 451-6900.