A commonly used blood thinner that can be a life-saver during hospital stays can turn deadly if given in too high a dose.
An overdose of the drug may have played a role in the death of a Texas toddler Wednesday at the Nebraska Medical Center, hospital officials said.
The officials said hospital staffers took steps Thursday to reduce the risk of future overdoses.
The drug, called heparin, gained wide attention three years ago after the newborn twins of actor Dennis Quaid nearly died from an overdose.
There have been other overdoses and deaths nationally involving heparin, said Allen Vaida of the Institute for Safe Medication Practices, a nonprofit group based in Pennsylvania.
Vaida said heparin, unlike some other drugs, can cause immediate problems for patients if given in too high a concentration. As a blood thinner it can cause internal bleeding, which can be life-threatening.
He said it's used during and after numerous surgeries and procedures for adults and children, including bone operations and open heart surgeries. Premature babies getting other medications or food intravenously often get the drug.
It's also commonly given while patients are receiving antibiotics intravenously or while undergoing kidney dialysis.
The Omaha death involved Almariah Duque, who was nearly 2.
“There's no good in being angry,” said her father Gregorio Duque, who is from Dallas, in a phone interview. “The only thing we want are answers.”
During a press conference Thursday evening, hospitals officials said they will provide them, but it will take time.
“First and foremost, we want to share our prayers and our condolences and express our sincerest apology,” Chief Nursing Officer Rosanna Morris said. “They are a beautiful family that had lots of dreams and hopes for their child.”
Morris and med center staffers said the following steps were enacted Thursday to prevent future problems with the drug.
»A second nurse will verify in writing that the proper dose of heparin was given. Previously, there was verbal verification.
»A pharmacy staffer will oversee from bedside the start of heparin delivery to a patient.
»The hospital will use technology that stops heparin infusions programmed to exceed maximum doses. Morris said the dose-stop technology wasn't used because it can interfere with providing the medication immediately to someone who's in urgent need of it.
Morris said some staff members are on leave as a result of what happened. She declined to elaborate.
She said med center employees and administrators continue to discuss what happened and why.
Ultimately, she said, the med center plans to share its findings with the medical community nationwide.
Duque said the overdose happened after his daughter was readmitted to the hospital following transplant surgery there.
The girl underwent small bowel, liver and pancreas transplants in December. She was making a good recovery and by early February was discharged and back with her parents in one of the hotel-style family rooms on the hospital's campus.
But she developed a virus and infection and returned to the Nebraska Medical Center on Feb. 13, her father said.
The virus caused her kidneys to shut down so she started undergoing dialysis, he said.
Her father said she was getting the heparin intravenously during the dialysis.
It is unclear exactly how the overdose occurred. He said hospital staff told him preliminarily that it appears the overdose, which happened Monday, occurred because “the setting on the IV pump was not checked properly.”
He said his daughter received the wrong dose for five hours before the problem was noticed.
He said the hospital told him it will take one to two months to complete a full investigation of why the overdose occurred.
The Joint Commission, which evaluates U.S. health care organizations, wrote in a 2008 report that when it comes to blood-thinners, or anti-coagulants, “pediatric patients are problematic to treat, specifically because the medications are formulated and packaged primarily for adults.”
Bona Benjamin of the American Society of Health-System Pharmacists agreed.
She said most ready-to-use, commercially prepared heparin is in adult concentrations.
That means hospital pharmacies often make the concentration needed by infants and young children. Nurses sometimes make the concentration, she said.
There is generally less risk with the commercially prepared concentration because it is done through an automated process. When the concentration is made at the hospital, it's done by people, so there is a greater possibility of error, she said.
Other hospitals say they follow steps to make sure the drug is given safely.
“We've put a lot of things in place to mitigate some of the risk,” said Lisa Kwapniowski, pharmacy manager at Children's Hospital & Medical Center.
Children's classifies heparin as a “high risk” medication so everyone is to be more alert when using it.
Higher concentrations are stored in the controlled-substance vault at Children's so they aren't confused with lower concentrations.
With high-risk medicines, Kwapniowski said, it's mandatory that two nurses check the drug and the dose before administering it. A patient's weight determines the dose.
If the dose is too high for the patient's weight, she said, the intravenous-dispensing technology won't work.
Further, heparin orders must be entered by computer at Children's. That way handwriting is eliminated and the computer system will alert the prescriber if the dose is too high for the patient's weight, she said.
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