Download Examples of life saving Interventions by ROE

Examples of Significant Interventions performed by Remote Order Entry
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Example 1
– Immediate-release dosage form of diltiazem, a drug used to treat high blood
pressure, tachycardia and atrial fibrillation was ordered with a once daily
frequency via CPOE.
– The dose was for the extended release amount. The nurse had verified the CPOE
order in the nursing module thereby accepting the dose from her perspective (A
pharmacist review still had to occur before the medication could be accessed)
– The use of this immediate-release form would have resulted in the patient
receiving a high dose too quickly. The remote pharmacist contacted the
patient’s nurse and the order was changed to delayed-release dosage form.
– Intervention by the remote pharmacist resulted in the patient receiving the
appropriate dosage form and avoided a potential adverse drug event
(hypotension, bradycardia).
Example 2
– On admission medication reconciliation, the physician ordered continuation of
all home medications, including an order for digoxin 0.5 mg po daily. Our
remote pharmacist immediately recognized the dose as abnormally high.
– The pharmacist contacted the nurse and requested that the patient be asked
about the history of the medication. The patient responded that a retail
pharmacy had previously ran out of 0.25 mg tablets and had instructed the
patient to take two 0.125 mg tablets for a total daily dose of 0.25 mg (the
intended dose).
– When the retail pharmacy obtained the original dose they provided the
medication but the patient continued to take two pills. This prolonged overdose
resulted in high serum digoxin levels. The side effects were potentially deadly
and resulted in several admissions to larger hospitals for adverse cardiac
events.
– The events went undiagnosed until our remote pharmacist caught the
medication error upon admission after normal pharmacy hours. The medication
was held, blood levels were drawn, EKG’s were performed, the physician was
contacted and the patient successfully recovered.
– Although the patient had been to other hospital on 3 separate occasions within
the last month this issue was not resolved until the intervention was performed
by our pharmacist.
Example 3
– Potassium chloride 80mEq orally every 2 hours for 6 doses was ordered for a
patient with a serum potassium level of 2.7 at 1000.
– Our remote pharmacist questioned the dose when the order required
verification at 1900 due to a change in timing of the doses. The remote
pharmacist requested a serum potassium level since the patient had already
received 4 doses for a total of 320 mEq of oral potassium chloride.
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The level was ordered and the subsequent doses were discontinued since the
patient’s serum potassium had risen to 4.1.
– Intervention by the remote pharmacist prevented a potentially life-threatening
medication event (hyperkalemia) and the additional discomfort of the patient in
receiving high doses of oral potassium.
Example 4
– N-acetylcysteine order for acetaminophen overdose was ordered via CPOE by
the physician. Upon review of the calculated doses the remote pharmacist
determined that the doses ordered by the physician were too low.
– The remote pharmacist attempted to contact the patient’s nurse to verify what
had been administered and how much had been given. The nurse was informed
that the dose had originally been calculated incorrectly and called the doctor
who confirmed our remote pharmacist’s dose and ordered the nurse to restart
the treatment.
– This incident occurred on a Friday night in a hospital pharmacy setting with no
onsite weekend coverage. Had the remote pharmacist not been available and
covering this particular hospital the patient would have likely suffered
irreversible liver damage as a result of the delayed effective treatment of an
acetaminophen overdose.
Example 5
– Regular insulin 50 units subcutaneous every morning and every afternoon at
1600 was ordered via CPOE on a new admission.
– The remote pharmacist contacted the nurse to request verification of the insulin
product and dose. The nurse indicated that the patient stated that she uses that
product and dose at home.
– The remote pharmacist then spoke with the ordering physician and he agreed to
discontinue the order until the dose could be verified with the patient’s
physician or pharmacy.
– Intervention by the remote pharmacist prevented a potentially life threatening
medication event (hypoglycemia).