Evaluation of Treatment with Oseltamivir during the 2009 H1N1 (Swine Flu) Pandemic: The Problem of Incomplete Clinical Information

Abstract

During the H1N1 (swine flu) pandemic of 2009, the World Health Organization (WHO) confirmed more than 14,000 deaths globally; this included a death toll of 147 in Iran. In order to evaluate (a) the appropriateness of the Oseltamivir dose through calculation of a patient's creatinine clearance (CrCl) and (b) the quality of data in the medical charts, we conducted a retrospective study at the Shariati Hospital in Tehran. All admissions to the hospital between the dates i October 2009 and 31 January 2010 were evaluated, amounting to a total of 51 patients' charts, including 8 outpatient charts. Of these 51 charts, 26 (51%) contained all the information necessary to evaluate the CrCl. However, there was at least one piece of information missing (e.g. the patient's weight; serum creatinine) from each of the remaining 25 charts (49% of the sample), which made it impossible for us to evaluate the dose. These results demonstrate how crucially important it is to ensure that all the necessary patient information is correctly registered at the time of admission in order to minimise medication errors.

Keywords

Drug Utilization Evaluation Oseltamivir Medical Records: Evaluation Iran Health Information Management Swine-Origin Influenza H1N1 Virus

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References

American Pharmacists' Association (APhA) (2009). Drug information handbook.Ohio, LEXI-COMP.

Arroliga

Pien

(2003). Penicillin allergy: Consider trying penicillin again. Cleveland Clinic Journal of Medicine 70(4): 313–4, 317–18, 320–21.

Bates

Leape

Cullen

(1998). Effects of computerized physician order entry and a team intervention on prevention of serious medication errors. Journal of the American Medical Association 280: 1311–16.

Benjamin

(2003). Reducing medication errors and increasing patient safety: Case studies in clinical pharmacology. Journal of Clinical Pharmacology 43: 768–83.

CDC (2009). Interim guidance for infection control for care of patients with confirmed or suspected novel influenza A (H1N1) virus infection in a healthcare setting. Atlanta, GA, US Department of Health and Human Services, CDC. Available at: health.state.tn.us/…/TDH%20Infection%20Control%20Guidelines.pdf (accessed15 July 2010).

Fahimi

Baniasadi

Behzadnia

(2008). Enoxaparin utilization evaluation: An observational prospective study in medical patients. Iranian Journal of Pharmaceutical Research 7(1): 77–82.

Glare

(2007). Enoxaparin in NSTE ACS-Incorrect doses lead to worse outcomes. Archives of Internal Medicine 167: 1539–44.

Himler

Rangiah

Bajorek

(2007). Failure to weigh patients in hospital: A medical safety risk. Internal Medicine Journal 37: 647–50.

Macie

Forbes

Foster

(2004). Dosing practices and risk factors for bleeding in patients receiving enoxaparin for the treatment of an acute coronary syndrome. Chest 125: 1616–21.

10.

Rybak

(2006). The pharmacokinetics and pharmacodynamics of vancomycin. Clinical Infectious Diseases 42 (suppl-1): S35–S39. Available at: http://cid.oxfordjournals.org/content/42/Supplement_1/S35.full.

11.

Rybak

Lomaestro

Rotschafer

(2009). Therapeutic monitoring of vancomycin in adult patients: A consensus review of the American Society of Health System Pharmacists and Infectious Diseases Society of America. Available at: www.ajhp.org/content/66/1/82.full.pdf+html.

12.

Spicer

Gibson

Bloe

(2009). Weight assessment in cardiac patients: Implications for prescription of low molecular weight heparin, enoxaparin. Postgraduate Medical Journal 85: 124–27.

13.

CDC (2009). Update: Novel influenza A (H1N1) virus infection Mexico, March-May, 2009. Atlanta, GA, US Department of Health and Human Services, CDC. Available at: http://www.ncbi.nlm.nih.gov/pubmed/19498336 (accessed 5 June 2010).

14.

Weisdorf

Lysne

Wind

(1987). Positive effect of prophylactic total parenteral nutrition on long term outcomes of bone marrow transplantation. Transplantation 43: 833–38.

15.

World Health Organization (WHO) (2010). Pandemic (H1N1) 2009 - update 84. Available at: Retrieved, from http://www.who.int/csr/don/2010_01_22/en/index.html (accessed 15 March 2010).

16.

Ziegler

(2009). Parenteral nutrition in the critically ill patient. New England Journal of Medicine 361: 1088–97.