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correspondence: Kwaku Marfo Montefiore-Einstein Center for Transplantation, Department of Pharmacy, Montefiore Medical Center, The University hospital for Albert einstein college of Medicine, 111 east 210th street, Bronx, nY 10467, UsA Tel +1 718 920 3752 Fax +1 718 798 0722 email kmarfo@montefiore.org Background: Medication errors are a prime concern for all in healthcare. As such the use of information technologies in drug prescribing and administration has received considerable attention in recent years, with the hope of improving patient safety. Because of the complexity of drug regimens in renal transplant patients, occurrence of medication errors is inevitable even with a well adopted computerized physician order entering (CPOE) system. Our objective was to quantify medication error type and frequency in an inpatient renal transplant unit. Methods: Systemic evaluation of all medication errors during an initial 10-day audit and a 28-day follow-up audit in an inpatient renal transplant unit. Each error was concurrently evaluated for potential to result in adverse patient consequences (category), error type and associated medication class. Results: A total of 103 clinically significant medication errors were detected during the 10-day (43 errors) and 28-day audit (60 errors) time periods. The most common errors were wrong medication dose ordered and wrong time of drug administration. Thirty-six out of 66 prescribing/ ordering errors reached the patient. Conclusions: Even with utilization of computerized physician order entry system in an inpatient renal transplant unit, post-kidney transplant patients are at risk for adverse outcomes due to medication errors. The risk factors may be multifactorial and will require both organizational and technical approaches to resolve.

Medical therapeutics has entered a new and exciting era with the development of biological agents that target specific sites. In the studies performed to date, natalizumab, a humanized monoclonal antibody to alpha4 integrin, when administered intravenously at monthly intervals, appeared to be highly beneficial with respect to decreasing both relapse rate and contrast-enhancing lesions in multiple sclerosis. Salutary actions on other disease parameters were also observed. However, treatment with natalizumab was complicated by the development of a rare demyelinating disease of the brain--progressive multifocal leukoencephalopathy (PML)--that developed in three patients in clinical trials of the drug. Currently, the estimated incidence for the development of PML with natalizumab treatment is 1:1,000 after approximately 18 months of therapy; however, as the development of PML is a stochastic event, it is quite possible that higher rates will be observed after longer treatment courses. Curiously, other opportunistic infections were not observed at higher rates in the treated groups when compared to controls, suggesting a specific association between natalizumab, and perhaps other alpha4 integrin blockers, and PML. Postmarketing surveillance studies should answer this and other questions related to the use of natalizumab.