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Program Description
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.
Watch Dr. O’Donnell testify in a murder case
After this one hour webinar you will be able to:
- List the common anticoagulants in clinical use; describe their mechanism of action, onset and duration of antidotes, treatment for overdose
- Identify common reference material for clinical monitoring, the types of laboratory tests measured when treating patients with anticoagulants
- Describe common medication errors by nurses and pharmacists leading to anticoagulant toxicity
- Identify common drug interactions enhancing or diminishing anticoagulant effect, leading to bleeding injuries or lack of effect (risk of clots)
- 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.)
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.
Related Reading
Excerpt from “Anticoagulants: A Double Edged Sword
by Patricia Iyer
Anticoagulants are life-saving drugs used to prevent both arterial and venous clots. Arterial clots are the most common cause of myocardial infarction, stroke, and limb gangrene. Venous clots, which typically arise in legs, may travel to the lungs to create a pulmonary embolism which shuts off circulation to part of the lung, and may cause death. Anticoagulants are used to prevent these events, and are commonly given to patients with atrial fibrillation (irregular heart beat), mechanical heart valves, after hip surgery, and for a score of other reasons. Anticoagulants do not have the capacity to break up existing clots- their focus is on prevention.
These medications can save lives, but also kill. They are singled out as high-risk medications by several patient safety organizations: The Institute for Safe Medication Practices, the Institute of Healthcare Improvement, the Joint Commission, and the US Pharmacopeia. High risk drugs, including Heparin, are involved in more than 31 percent of all medication errors that cause harm to patients. They carry a heightened risk of causing significant harm to patients when administered incorrectly or in error. Sixty percent of life-threatening or lethal errors involve intravenous drugs such as Heparin.
Anticoagulants can be implicated in a variety of personal injury and medical malpractice claims. Consider these scenarios:
- Medication errors may occur during administration of anticoagulants, such as the error that recently affected the newborn twins of actor Dennis Quaid. The newborns received 10,000 units of Heparin instead of 10 units at a California hospital. The Quaids sued the manufacturer of the drug because the packaging of the 10 unit per cc vial of Heparin looked almost exactly like the 10,000 units per cc vial.
- Anticoagulants can turn a bump on the head into a tragedy. This is a common fact pattern. An elderly man who was taking Coumadin, an oral anticoagulant that slows clotting time, fell on the ice and hit his head. Bleeding began within his brain, causing death. The patient’s attorney filed a personal injury claim.
- Intramuscular injections given to a person on Heparin may cause extensive damage. In one case, physicians ordered a variety of medications to be given by intramuscular injections to a patient who was receiving Heparin. When the patient’s clotting time rose above the therapeutic values, the injections caused the development of a hematoma- collection of blood in her right buttock. This in turn pressed on the sciatic nerve, causing a foot drop. The patient’s son, who was a medical malpractice attorney, filed a claim and settled the case.
- The clotting time of a woman rose while she was on Heparin. When her hemoglobin began to drop, indicating she was bleeding, the physician delayed ordering blood transfusions. The patient died from blood loss. A wrongful death suit was filed.
