icu

The ICU From the Pharmacy Perspective

　　Judith Jacobi, PharmD,[18] of Methodist Hospital, Lebanon, Indiana, reviewed the pharmacist's perspective of ICU errors. Errors involving medications (adverse drug events) are the largest single cause of medical errors in the hospitals. Fifty-six percent of them are due to incorrect ordering, 34% to administration, and 10% to dispensing and transcription.
　　Bates and coworkers[19] studied medication errors and reported 2 serious errors per 100 admissions. The preventable errors prolonged length of stay for 4.6 days and added $2.8 million to the cost in a 700-bed teaching hospital over a 6-month period.
　　As a consequence of this increased awareness, in 1999, a partnership was established among the American Hospital Association, the Health Research and Educational Trust, and the Institute for Safe Medication Practices. Supported by the Commonwealth Fund, the Pathways for Medication Safety was created.[20] The goal is to "create nonpunitive, system-based approaches to reduce adverse events and errors in hospitals." The organization hopes to achieve its goal by leading a strategic planning effort, looking collectively at risk assessing, and promoting bedside bar-coding readiness.[20] A multidisciplinary core team, including practitioners, senior administrators, physicians, and managers, is suggested. Critical care representation and implementation are crucial. Some of the key elements are patient and drug information, communication of drug orders, proper labeling and packaging, staff competency and education, quality process, and risk management. A blame-free environment is essential for the success of the program. There is new technology available that automates and secures the prescription/dispensation/administration process. The extra cost is justified based on the potential monetary and life saving the new technology can offer.
　　In a study by Calabrese and colleagues,[21] 5744 observations of drug administrations were undertaken in 851 ICU patients in 5 ICU units. A total of 187 (3.3%) medication administration errors were detected, with the wrong infusion rate (71, 40.1%) being the most common. The drugs most commonly associated with errors were vasoactive drugs (61, 32.6%) and sedative/analgesics (48, 25.7%). Five errors required increased patient monitoring and 2 required intervention. None of the errors resulted in patient death. Although the multicenter evaluation found fewer medication administration errors than the published literature, it is still cause for concern. Delivery devices have been tried for years to reduce errors. Newer computer-based intravenous pumps are safer and more user friendly. They also permit dosing overrides and adverse drug events to be recorded. This allows for retrospective review and improvement.
　　Besides implementing new technology, the pharmacist may have a major affect on the reduction of medical errors as part of an ICU team. Studies have shown that the participation of a pharmacist on rounds, implementation of a regular order review process, and pharmacist-acquired medication history dramatically reduce errors and costs.[7,22]
　　Dr. Jacobi concluded that the pharmacy should not be part of the problem of errors in the ICU. Newer technologies should be introduced and the personnel should be educated in their use. Constant human vigilance is always required.