OBJECTIVES: An evaluation of risk factors for adverse drug events in critically ill patients has not been previously studied. The purpose of this original study was to determine risk factors for adverse drug events in critically ill adult patients. DESIGN: This retrospective case-control study includes patients who were admitted to the intensive care unit during a 7.5-yr period. SETTING: Academic medical center with 647 beds that contains approximately 120 intensive care unit beds. PATIENTS: Patients in the case group experienced an adverse drug event as documented in the hospital's database. The control group comprised the next two patients admitted to the same intensive care unit by the same admitting service. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Twenty-nine suspected risk factors identified from the literature were evaluated, including patient characteristics, drug characteristics, and laboratory values using a multiple logistic regression. A sample of 1101 cases and controls (54% male), with a mean age of 59.4 ± 17.5 yrs, were identified. In 367 cases, there was a total of 499 documented adverse drug events. Patients with kidney injury, thrombocytopenia, and those admitted emergently were 16-times, 3-times, and 2-times more likely to have an adverse drug event, respectively. Patients who were administered intravenous medications had a 3% higher risk of having an adverse drug event for each drug dispensed. Overall, the case group received more drugs per intensive care unit day and more drugs per intensive care unit stay. CONCLUSIONS: Several patient and drug-related characteristics contribute to the risk of adverse drug events in critically ill patients. Diligent monitoring of factors that can influence the pharmacokinetic properties for existing drug therapies is necessary. Drug regimens should be evaluated daily for minimization. Based on previous studies, pharmacists as part of the interdisciplinary team could help to manage these risks.
OBJECTIVES: An evaluation of risk factors for adverse drug events in critically illpatients has not been previously studied. The purpose of this original study was to determine risk factors for adverse drug events in critically ill adult patients. DESIGN: This retrospective case-control study includes patients who were admitted to the intensive care unit during a 7.5-yr period. SETTING: Academic medical center with 647 beds that contains approximately 120 intensive care unit beds. PATIENTS: Patients in the case group experienced an adverse drug event as documented in the hospital's database. The control group comprised the next two patients admitted to the same intensive care unit by the same admitting service. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Twenty-nine suspected risk factors identified from the literature were evaluated, including patient characteristics, drug characteristics, and laboratory values using a multiple logistic regression. A sample of 1101 cases and controls (54% male), with a mean age of 59.4 ± 17.5 yrs, were identified. In 367 cases, there was a total of 499 documented adverse drug events. Patients with kidney injury, thrombocytopenia, and those admitted emergently were 16-times, 3-times, and 2-times more likely to have an adverse drug event, respectively. Patients who were administered intravenous medications had a 3% higher risk of having an adverse drug event for each drug dispensed. Overall, the case group received more drugs per intensive care unit day and more drugs per intensive care unit stay. CONCLUSIONS: Several patient and drug-related characteristics contribute to the risk of adverse drug events in critically illpatients. Diligent monitoring of factors that can influence the pharmacokinetic properties for existing drug therapies is necessary. Drug regimens should be evaluated daily for minimization. Based on previous studies, pharmacists as part of the interdisciplinary team could help to manage these risks.
Authors: Eric G Poon; Jennifer L Cina; William Churchill; Nirali Patel; Erica Featherstone; Jeffrey M Rothschild; Carol A Keohane; Anthony D Whittemore; David W Bates; Tejal K Gandhi Journal: Ann Intern Med Date: 2006-09-19 Impact factor: 25.391
Authors: A K Jha; G J Kuperman; J M Teich; L Leape; B Shea; E Rittenberg; E Burdick; D L Seger; M Vander Vliet; D W Bates Journal: J Am Med Inform Assoc Date: 1998 May-Jun Impact factor: 4.497
Authors: Jeffrey M Rothschild; Christopher P Landrigan; John W Cronin; Rainu Kaushal; Steven W Lockley; Elisabeth Burdick; Peter H Stone; Craig M Lilly; Joel T Katz; Charles A Czeisler; David W Bates Journal: Crit Care Med Date: 2005-08 Impact factor: 7.598
Authors: R Scott Evans; James F Lloyd; Gregory J Stoddard; Jonathan R Nebeker; Matthew H Samore Journal: Ann Pharmacother Date: 2005-05-16 Impact factor: 3.154
Authors: Emily R Hajjar; Joseph T Hanlon; Margaret B Artz; Catherine I Lindblad; Carl F Pieper; Richard J Sloane; Christine M Ruby; Kenneth E Schmader Journal: Am J Geriatr Pharmacother Date: 2003-12
Authors: Sonia Pinkney; Mark Fan; Katherine Chan; Christine Koczmara; Christopher Colvin; Farzan Sasangohar; Caterina Masino; Anthony Easty; Patricia Trbovich Journal: Ont Health Technol Assess Ser Date: 2014-05-01
Authors: Pamela L Smithburger; Mitchell S Buckley; Mark A Culver; Sarah Sokol; Ishaq Lat; Steven M Handler; Levent Kirisci; Sandra L Kane-Gill Journal: Crit Care Med Date: 2015-08 Impact factor: 7.598
Authors: Pascale Carayon; Tosha B Wetterneck; Randi Cartmill; Mary Ann Blosky; Roger Brown; Robert Kim; Sandeep Kukreja; Mark Johnson; Bonnie Paris; Kenneth E Wood; James Walker Journal: BMJ Qual Saf Date: 2013-09-19 Impact factor: 7.035
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Authors: Steven M Handler; Pui Wen Cheung; Colleen M Culley; Subashan Perera; Sandra L Kane-Gill; John A Kellum; Zachary A Marcum Journal: J Am Med Dir Assoc Date: 2014-05-10 Impact factor: 4.669
Authors: Mark Fan; Christine Koczmara; Caterina Masino; Andrea Cassano-Piché; Patricia Trbovich; Anthony Easty Journal: Ont Health Technol Assess Ser Date: 2014-05-01