Elspar

Poor communication dynamics among health care providers may hinder recognition of medication errors. Yet, continued persistence in communicating recognized problems, even if there is opposition from experts, often results in correcting errors before they reach patients.

Recently, an attending physician ordered pegaspargase (Oncospar) for a patient with acute lymphoblastic leukemia who had previously developed an allergic reaction to asparaginase (Elspar). The preferred route of administration for pegaspargase is LM.; the IN. route increases the incidence of cross-reactivity in asparaginase-sensitive patients and the possibility of liver toxicity, coagulopathy, and gastrointestinal and renal disease.

Before pegaspargase was available, an asparaginase desensitization protocol was commonly used to treat patients with hypersensitivity by rapidly administering the drug LV In this case, the physician ordered pegaspargase IN. with a dosing schedule similar to that for the asparaginase desensitization regimen, rather than a single LM. dose as indicated for pegaspargase.

To clarify the order, the pharmacist called the attending physician, who was reluctant to change the order because he had reviewed its contents with the director of the protocol under which this drug was being used. When the protocol director was called, he confirmed that he had suggested using the asparaginase desensitization routine with pegaspargase.

Further persistence by the pharmacist identified that the protocol director was unaware of the risks of administering pegaspargase LV and had never before prescribed it using a desensitization regimen. He thought it would be the safest thing to do. Everyone eventually agreed that the drug should be administered as a single LM. dose.

In this case, an experienced pharmacist was able to resolve the issue through patience, persistence, and trusting his own expertise to augment the expertise of others. Prescribers should not be afraid to question orders or to be questioned about orders when a patient may be at risk.

Caution should be exercised when evidence is presented to prove that the order is accurate and safe (see Table). These "red flag" phrases should trigger health care providers to request more reliable answers or evidence.

Copyright Springhouse Corporation Oct 1999
Provided by ProQuest Information and Learning Company. All rights Reserved