Pulmonary arterial hypertension (PAH) remains a progressive, life-threatening disease with no cure. Epoprostenol and treprostinil are intravenous medications administered by continuous ambulatory infusion pump. This study explored hospital policies regarding prostacyclin infusions, and investigated the type and frequency of errors that occurred in the inpatient setting.
This project consisted of three phases: First, 11 hospital pharmacists were surveyed about prostacyclin infusion policies. Second, nurses at 18 large PAH centers were interviewed about prostacyclin policies and errors. Finally, a survey was sent to clinicians treating PAH patients, with 108 respondents.
POLICIES: The pharmacy and nursing surveys revealed a lack of standardization including variability on policies regarding use of home vs. hospital infusion pumps, and variability in the existence and storage of back-up cassettes on nursing units. This was confirmed in the larger electronic survey: 56% kept patients on their home infusion pumps, 59% kept back-up epoprostenol on the nursing unit and 31% kept back-up treprostinil on the unit. ERRORS: In the phone survey, 17 of 18 PAH nurses reported serious errors related to inpatient prostacyclin infusions, including 3 that resulted in death. In the electronic survey, errors resulted in 28 serious adverse reactions and 9 deaths. Half the respondents did not leave center names, so duplications could have occurred. Common errors (more than 20 each) included: wrong patient's cassette placed in the pump, wrong rate programmed into the pump, wrong medication concentration used, and pump inadvertently stopped. POLICY CHANGES: Many centers made at least one policy change in an attempt to reduce future errors, including removing back-up cassettes or bags from nursing units and having two nurses sign off on dose changes.
In this study, multiple fatal and other serious errors were reported with the use of inpatient prostacyclin medications.
Clinicians caring for patients receiving intravenous prostacyclins should be aware of the high risk of administering these medications. Further study is needed to determine the best ways to reduce these errors.
Martha Kingman, University grant monies None; Grant monies (from sources other than industry) None; Grant monies (from industry related sources) None; Shareholder None; Employee Mark Tankersley is employed by Accredo, which is involved in the distribution of treprostinil, manufactured by United Therapeutics, and epoprostenol, manufactured by Glaxo SmithKline and Teva. He provided expertise on the home infusion process, survey methadology, and statistical analysis. No direct financial support from Accredo was provided for the project.; Fiduciary position (of any organization, association, society, etc, other than ACCP None; Consultant fee, speaker bureau, advisory committee, etc. Martha Kingman, Kelly Chin, Fernando Torres and Sandra Lombardi have received honoraria from United Therapeutics Inc. and Gilead Inc., companies that manufacture or distribute intravenous prostacyclins.; No Product/Research Disclosure Information