News in brief: VTE prophylaxis death blamed on EMR failings; Aussie trial confirms convalescent plasma is ‘futile’ for critically ill COVID-19 patients; RACP trainees receive legal warning on feedback reports

Thursday, 7 Oct 2021

VTE prophylaxis death blamed on EMR failings;

Failure to give VTE prophylaxis to an elderly woman resulted in her death, which a Victorian coroner has blamed on poor functionality of a new Electronic Medical Record (EMR) system. A coronial investigation found that the elderly women had been admitted by Alfred Health for cancer radiotherapy treatment and had risk factors for VTE such as immobility. However, despite having VTE prophylaxis as part of her management plan from her medical team, this was not implemented. The investigation found this was because of poor communication between staff and a lack of VTE prophylaxis notifications on the new EMR system, which had just gone live. The coroner recommended that hospitals and regulators of digital health systems be reminded of the importance of having VTE risk assessments embedded in EMR systems and alerts for VTE prophylaxis provided in electronic medication charts.

RACP trainees receive legal warning on feedback reports

The RACP has warned trainees not to identify any peers or patients when submitting reports on ‘significant events’ that impacted on their medical professionalism as part of the personal reflection required  for training purposes.

The Commonwealth government has ruled that legal Qualified Privilege no longer applies to Professional Qualities Reflection (PQR) activities in Australia, which means that information and documents used in the reflections may be obtained and used in medicolegal actions.

The RACP says documents created before 1 October 2021 will continue to be protected from disclosure, but it “strongly advises de-identifying the names of patients, peers, persons or organisation(s) as well as any information entered in Professional Quality Reflection” after this date.

“If a trainee personally receives a Subpoena or a court order to reveal any Quality Assurance Activity Records, the College encourages them to seek legal advice regarding whether those records must be produced,” it advises.

Aussie trial confirms convalescent plasma is ‘futile’ for critically ill COVID-19 patients

Convalescent plasma does not improve outcomes in critically-ill COVID-19 patients, according to an international study that included Australian centres.

A clinical trial of two units of high-titre, ABO-compatible convalescent plasma in 1,990 critically-ill adults with COVID-19 found plasma use made little difference to patients’ median number of organ support-free days (0, IQR: -1–16 vs 3, IQR: -1–16).

Patients also had similar in-hospital mortality rates (37.3% vs 38.4%) and median number of days alive and off organ support (14, IQR: 3–18 vs 14, IQR: 7–18), regardless of plasma use, the REMAP-CAP study investigators wrote in JAMA, noting that the treatment’s probability of futility was 99.4%.

Additionally, plasma recipients had a higher rate of serious adverse events than non-recipients (3.0% vs 1.3%).

The authors said the results were consistent with convalescent plasma’s lack of benefit for hospitalised patients with moderate or severe COVID-19, as reported in the RECOVERY trial, and suggested there was little-to-no point in offering the treatment for that indication.

The REMAP-CAP study was conducted at multiple global centres with participants from Monash University, Monash Health and Alfred Health, Melbourne University, the Australian Red Cross Lifeblood, Sydney and Perth; Western Sydney University, St John of God Hospital, Perth and the University of Western Australia.


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