Onco 18 – Chemotherapy – an outline.

Why are they some of the most difficult and painful drugs to be on.

Join us as pharmacist Alana give us a quick insight into oncology drugs: their principles, side effects, targeted therapy and much more.

Checklists – How we can reduce harm done in medicine

Doctors are humans, and humans are not perfect. We will all make mistakes sometime in our life, and because of our job, we can risk harming patients.

The teaching theme this week at university was medicinal safety – teaching us common prescribing errors and bad habits junior hospital doctors often make due to inexperience. Habits such as using abbreviations, writing ambiguous directions, and even bad handwriting seemed were common reasons for medical emergencies to occur. The important thing to remember is that these could all be preventable.

The following is a list of some bad habits that could be easily fixed to prevent patients from prescribing errors.

  • Write drugs in their generic (drug) name – don’t write the drug in abbreviations or in the brand name

    • e.g 1. How many people know that DDAVP is an abbreviation for desmopressin
    • e.g. 2. Cyclosporin (Chemo drug) was accidentally given instead of Cyklokapron (Tranexamic acid used to stop heavy bleeding)
  • Use your decimal points carefully – People can lose the decimal point
    • e.g WRITE 0.5mg instead of .5mg because people can easily miss the decimal point and administer 5mg
    • e.g. But write 100mg instead of 100.0mg because the decimal point can be missed and 1000mg will be administered instead.
  • Clearly articulate your dosing directions – spell out your intentions
    • Don’t use OD,BD,TDS and instead write Daily, Twice Daily, Three times daily
  • If you don’t know what you’re charting, look it up or ask for help.
    • There were cases where dosing errors were copied from the previous chart to the next as the doctor just transcribed the drug directions out of uncertainty.

There are many more good prescribing habits that could be found in your local hospital procedure guidelines. If in doubt, have a look there. Otherwise, grab a pharmacist and ask for help!

One very interesting point brought up in class was to use checklists. In certain parts of the world, hospitals are implementing checklists as part of day-to-day practice to reduce preventable harm in medicine. The idea may have originated from airline companies that use checklists as a way to reduce errors on board an aircraft.

I love this idea and it sounds awesome. This is a simple and cost-effective way for doctors to double-check everything is in order before starting or finishing a procedure.

On the other hand, I’m aware that people are against the idea of checklists. Some doctors feel that checklists limits their autonomy, others feel that they have experience and know what to do and thus don’t see the need of it.

This may be the case for some people, but for the most of us errors are bound to be made in busy and stressful situations. It doesn’t hurt to be more careful, especially if the harm goes towards your patients.

Where do you stand on checklists?

Knowing your anti-coagulants and anti-platelets

I’ve noticed as a student that lots of people get them confused. It’s simple because they both thin the blood right?

Unfortunately, it’s not appropriate to mix up the two terms. Precision is key guys!

Want a quick two min crash course? Read on!

Anti-platelets

Affect primary hemostasis as they target platelet aggregation. Platelet aggregation involves linking to other platelets through fibrinogen through receptors called glycoprotein 2b3a (GP2b3a). This linking forms a platelet plug.

Antiplatelet

Aspirin – inactivates cyclo-oxygenase 1 (COX-1) there by reducing Thromboxane A2 (TXA2) which promotes aggregation. Clopidogrel – inhibit ADP dependent aggregation. This reduces the ability for the GP2b3a receptor to be expressed. GP2b3a antagonists (Abciximab) – prevents fibrinogen to bind to the receptor.

Anti-coagulants

Act on the coagulation cascade. The coagulation cascade occurs in secondary hemostasis with the primary goal to convert fibrinogen into fibrin. This would stabilize the platelet plug as fibrin a lot more stable than fibrinogen.

Anti-Coagulant

Warfarin – prevents the synthesis of Vit K dependent coag factors (2,7,9,10, C and S). Heparin – activates anti-thrombin 3 (AT3) and has an effect on thrombin and Xa. Low Molecular Weight Heparin – activate AT3 but only has an effect on Xa. Xa inhibitors – inhibit Xa. Direct thrombin inhibitors inhibits thrombin.

From this, I hope you can see why it’s very wrong to call warfarin an anti-platelet. Similarly, aspirin is not an anti-coagulant.