PMID- 25977126
OWN - NLM
STAT- MEDLINE
DCOM- 20151007
LR  - 20191027
IS  - 1553-7250 (Print)
IS  - 1553-7250 (Linking)
VI  - 41
IP  - 3
DP  - 2015 Mar
TI  - Monitoring the harm associated with use of anticoagulants in pediatric 
      populations through trigger-based automated adverse-event detection.
PG  - 108-14
AB  - BACKGROUND: The safety profile of anticoagulants, which are being used with 
      increasing frequency in pediatric populations, is not well studied. Automatic 
      triggers built into electronic health record systems (EHR) have been shown to be 
      an effective way to monitor for and identify medication errors. 
      Anticoagulant-associated adverse events were examined through the use of an 
      anticoagulant trigger panel. METHODS: In a retrospective, five-year (September 
      2007-September 2012) observational study, four automated triggers were used to 
      detect anticoagulant-related adverse events: activated partial thromboplastin 
      time (aPTT) > 100 seconds in patients on an unfractionated heparin (UFH) 
      infusion, International Normalized Ratio (INR) > 4, anti-factor Xa (anti-FXa) 
      >1.5U/mL for patients on enoxaparin, and the documented use of protamine. 
      RESULTS: For the 1,664 triggers evaluated, 12 were associated with the aPTT 
      trigger, only 1 of which was preventable. Receiver operator characteristic curve 
      analysis indicated that increasing the aPTT trigger > 140 seconds would optimize 
      sensitivity and specificity. The INR trigger identified four outpatients with 
      adverse events. No adverse events were associated with the anti-FXa trigger. The 
      protamine trigger identified 12 adverse events and was associated with more 
      severe events. Minimal overlap was found with protamine and aPTT triggers. 
      CONCLUSION: Laboratory- and medication-based triggers can be effective monitoring 
      tools for anticoagulants. For patients receiving a UFH infusion, an aPTT cutoff 
      value of > 140 seconds is more precise. We also found that protamine use as a 
      trigger adds value to a trigger-based anticoagulant monitoring system. Continued 
      improvement in the logic algorithms associated with the EHR-based trigger tool 
      will allow expanded use of this tool in a clinical manner.
FAU - Patregnani, Jason T
AU  - Patregnani JT
AD  - Department of Pediatric Critical Care, Children's National Health System, 
      Washington, DC, USA.
FAU - Spaeder, Michael C
AU  - Spaeder MC
FAU - Lemon, Valere
AU  - Lemon V
FAU - Diab, Yaser
AU  - Diab Y
FAU - Klugman, Darren
AU  - Klugman D
FAU - Stockwell, David C
AU  - Stockwell DC
LA  - eng
PT  - Journal Article
PL  - Netherlands
TA  - Jt Comm J Qual Patient Saf
JT  - Joint Commission journal on quality and patient safety
JID - 101238023
RN  - 0 (Anticoagulants)
SB  - IM
MH  - Anticoagulants/*adverse effects
MH  - Drug Monitoring/*methods
MH  - Electronic Health Records/*organization & administration
MH  - Hospitals, Pediatric/*organization & administration
MH  - Humans
MH  - International Normalized Ratio
MH  - Medication Errors/*adverse effects
MH  - Partial Thromboplastin Time
MH  - Quality of Health Care
MH  - Retrospective Studies
EDAT- 2015/05/16 06:00
MHDA- 2015/10/08 06:00
CRDT- 2015/05/16 06:00
PHST- 2015/05/16 06:00 [entrez]
PHST- 2015/05/16 06:00 [pubmed]
PHST- 2015/10/08 06:00 [medline]
AID - S1553-7250(15)41015-3 [pii]
AID - 10.1016/s1553-7250(15)41015-3 [doi]
PST - ppublish
SO  - Jt Comm J Qual Patient Saf. 2015 Mar;41(3):108-14. doi: 
      10.1016/s1553-7250(15)41015-3.