Preventable Medication Errors: Solid Oral Dosage Forms of Diltiazem
Author(s): ,
Carol Nguyen
Affiliations:
RPh BHSc PharmD
Mi Qi Liu
Affiliations:
PharmD Candidate
Canadian Pharmacists Conference ePoster Library. Ho C. Jun 4, 2017; 174279
Dr. Certina Ho
Dr. Certina Ho
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Abstract
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Objectives
Hypertension is a significant risk factor for cardiovascular diseases such as stroke and heart attack, making blood pressure control an important priority in preventing these events. Available in a wide range of formulations, generics and doses, diltiazem is used to control blood pressure as a first or second line agent, with other Health Canada approved indications including stable angina and coronary spasms. If used incorrectly, diltiazem may lead to negative consequences including heart block and heart failure, and compromised patient safety. The objective of this multi-incident analysis was to examine potential contributing factors of medication incidents involving solid oral dosage forms of diltiazem, and provide recommendations with the aim to enhance medication safety.

Methods
Medication incidents involving solid oral dosage forms of diltiazem from January 2010 to April 2016 were extracted from a national incident reporting database. A total of 184 incidents were subjected to a qualitative, multi-incident analysis.

Results
The incidents were analyzed and categorized into two main themes: diltiazem-specific and medication-use process. Associated subthemes were identified for each main theme, with (1) different formulations and generics, (2) wide dosing ranges, (3) oral dosage forms, (4) drug interactions and (5) non-dihydropyridine calcium channel blocker role in drug therapy, under the main theme of diltiazem-specific; and (1) prescribing, (2) prescription order entry and (3) prescription preparation/dispensing under the main theme of medication-use process. Recommendations included physical separation or storage of look-alike bottles to minimize confusion with similar names and multiple strengths, and the performance of comprehensive medication review to assess the appropriateness of medication therapy for patients.

Conclusion
By sharing incident analysis findings and the lessons learned, we expect an increase in the understanding of medication errors involving diltiazem by pharmacy practitioners, followed by an active discussion and adoption of quality improvement measures that can advance safe medication use.

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