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Anticoagulation: Teetering on the Bleeding Edge

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Watch Dr. O’Donnell testify in a murder case

 


2 free articles with webinar:
"Forensic Pharmacist Report in a Coumadin Death Case"
and
"Pharmacist Practice and Liability"

 

    

This program is directed to attorneys, paralegals and legal nurse consultants.

The Heparin overdose of actor Dennis Quaid’s newborn twins drew attention to the dangers of anticoagulants: Heparin, Coumadin, Lovenox, and others. These drugs have a very narrow window of safety. Even in the best of circumstances, when everyone does everything right, these drugs can lead to significant toxicity and bleeding, permanent injury, paralysis, blindness, and death. Safe use requires understanding how they work (mechanism of interaction, onset and duration of action), using antidotes, and recognizing and avoiding drug interactions. Thorough and careful ordering, compounding, labeling, distribution, administration, and monitoring by healthcare workers is necessary for effective use of anticoagulants. If prescribers do not order enough anticoagulation, the patient does not receive the full effects and is at increased risk for blood clots or stroke. Medication errors by nurses and pharmacists may lead to therapeutic failure or life threatening bleeding episodes due to anticoagulant toxicity. Also, healthcare providers may lack understanding about drug interaction risks, and the use and interpretation of laboratory tests monitoring for safety and efficacy of anticoagulants. Healthcare providers have an obligation to educate patients about the complexities of the anticoagulation regimen to avoid under or overutilization of the medications.

Dr. James T. O'Donnell has 20 years of experience as a clinical pharmacist in acute care hospitals. He has been responsible for establishing and maintaining safe medication distribution and control systems. An experienced expert witness, Dr. O’Donnell will share lessons from the courtroom involving cases of injuries associated with misuse of anticoagulants.

After this one hour webinar you will be able to:

  1. List the common anticoagulants in clinical use; describe their mechanism of action, onset and duration of antidotes, treatment for overdose
  2. Identify common reference material for clinical monitoring, the types of laboratory tests measured when treating patients with anticoagulants
  3. Describe common medication errors by nurses and pharmacists leading to anticoagulant toxicity
  4. Identify common drug interactions enhancing or diminishing anticoagulant effect, leading to bleeding injuries or lack of effect (risk of clots)
  5. Determine which anticoagulants are commonly used together

As an added bonus, you will receive:

  • James O’Donnell, Forensic Pharmacist Report in a Coumadin Death Case, Journal of
    Pharmacy Practice
  • James O’Donnell, Pharmacist Practice and Liability, Journal of Nursing Law

Watch Dr. O’Donnell testify in a murder case. (Allow the commercial to finish first.)

CEUs are available for this program (click for details).



 
 

Presenter

Dr. James O’Donnell is a Professor of Pharmacology and frequent consultant in litigation in cases in which patients have suffered injury and/or death due to misuse of anticoagulants, as a result of inappropriate prescribing, inadequate monitoring, faulty compounding and labeling, and poor patient compliance. He has worked on high profile cases in the national news. He is responsible for medical college instruction on adverse drug reactions and drug interactions and is the editor of several “Drug Injury” books and more than 200 publications addressing drug injury.

Dr. James O’Donnell earned his Bachelor’s and Doctorate degrees in Pharmacy from the Universities of Illinois and Michigan respectively, and earned a Master’s degree in Clinical Nutrition from the Rush University. He is currently an Associate Professor and Course Director for Medical Pharmacology at the Rush University Medical Center. Dr. O’Donnell is also a Lecturer in the Department of Medicine at the University of Illinois College of Medicine. He is a Diplomate of the American Board of Clinical Pharmacology, a Fellow of the American College of Clinical Pharmacology, a Diplomate of the Board of Nutritional Specialties, and a Fellow in the American College of Nutrition, and member of several professional societies. He is a co-editor of Pharmacy Law, the editor of Drug Injury: Liability, Analysis, and Prevention, first and second editions, and co-editor of The Process of New Drug Discovery and Development. His publications include several chapters on medication errors in nursing malpractice books, and more than 200 articles on drug injury and prevention. In addition to his academic and editorial endeavors, he regularly consults in drug and pharmaceutical matters to industry, government, and law.

Moderator: Patricia Iyer MSN RN LNCC
Pat and James have coauthored four chapters on medication errors: three in Drug Injury: Liability, Analysis, and Prevention, edited by James, and one in Nursing Malpractice, Fourth Edition, in press, edited by Pat Iyer, Barbara Levin, Kathleen Ashton and Victoria Powell.


Article: "Summary of Clinical Use and Toxicity of Anticoagulant Therapy"

 

Excerpt from "Summary of Clinical Use and Toxicity of Anticoagulant Therapy"
by Dr. James O'Donnell

(read full article)

An anticoagulant is a substance that prevents coagulation; that is, it stops blood from clotting. A group of pharmaceuticals called anticoagulants can be used as a medication for thrombotic disorder. The irony of the disasters that follow anticoagulant mishaps is that most of their use is prophylactic, to decrease the risk of clotting (postoperatively, in atrial fibrillation, or even as simple as flushing intravenous catheters.)

Consider the following serious consequences of too much or too little anticoagulant:

  1. The pharmacist dispenses 2mg warfarin instead of 5mg; the patient’s routine INR is non-therapeutic. The hospital notification system fails. The woman has a stroke and is permanently disabled.
     
  2. The pharmacist dispenses warfarin instead of Cogentin; the technician testifies pharmacist doesn’t check her prescriptions. The patient dies of an intracerebral bleed.
     
  3. Nursery infants are administered 50x overdose of heparin for catheter flush (the Dennis Quiad case). Babies develop bleeding. California Nursing and Pharmacy Boards investigate hospital practices. Floor stocking with 5,000 unit/ml vials instead of 10 or 100 is discovered.
     
  4. Texas Hospital reports heparin overdoses in several infants. Heparin syringes compounded in hospital pharmacy contained excessive amounts of heparin. Some infants died of heparin overdose....

(read more)