Analysis of risk factors for adverse drug events in critically ill patients*

Abstract

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.

Prevalence of potential drug-drug interactions in the intensive care unit of a Brazilian teaching hospital

“…The large number of pDDIs between drugs prescribed to ICU patients has been documented by several studies (Smithburger, Kane-Gill, Seybert, 2012;Rivkin, Yin, 2011;Kane-Gill et al, 2012). A recent study conducted in the USA showed that 46.3% of ICU prescriptions included pDDIs (Smithburger, Kane-Gill, Seybert, 2012), while Brazilian studies have reported a prevalence of 67% or 70% (Hammes et al, 2008;Moreira, Cassiani, 2011).…”

Propofol-associated QTc prolongation

“…In addition to these risk factors, the acuity of illness of patients in the ICU may confer a predisposition for ADEs [Classen et al 1997;Sikdar et al 2012;Nebeker et al 2005;Smith et al 2012;Kane-Gill et al 2012;Barr et al 2013]. As such, close monitoring of medications in the ICU is imperative [Kane-Gill et al 2012;Barr et al 2013;Drew et al 2004;Pinsky, 2007].…”

“…The intensive care unit (ICU) setting imparts a particularly high risk of ADEs, as patients are typically severely ill and often require complex medications in the setting of altered pharmacokinetics [Classen et al 1997;Nebeker et al 2005;Smith et al 2012]. Numerous risk factors for ADEs have been identified in critically ill patients such as kidney injury, thrombocytopenia and use of intravenous medications [Kane-Gill et al 2012]. In addition to these risk factors, the acuity of illness of patients in the ICU may confer a predisposition for ADEs [Classen et al 1997;Sikdar et al 2012;Nebeker et al 2005;Smith et al 2012;Kane-Gill et al 2012;Barr et al 2013].…”

Segurança do paciente em unidades de terapia intensiva: ambiente das práticas profissionais de enfermagem e satisfação profissional na ocorrência de eventos adversos

“…Em relação ao tipo de tratamento, estudo também identificou o tratamento de emergência (clínico ou cirúrgico) em maior risco de EA pela necessidade do tratamento com medicamento intravenoso 61 . Além disso, os pacientes da UTI, principalmente quando submetidos a procedimentos cirúrgicos, apresentam maior número de dispositivos necessários a assistência e itens na prescrição medicamentosa, o que aumentam as chances de ocorrência de EA, como a infecção associada a assistência causada pela quebra de protocolos assistenciais ou mesmo a retirada não programada dos dispositivos 4,16 .…”

“…Além disso, os pacientes da UTI, principalmente quando submetidos a procedimentos cirúrgicos, apresentam maior número de dispositivos necessários a assistência e itens na prescrição medicamentosa, o que aumentam as chances de ocorrência de EA, como a infecção associada a assistência causada pela quebra de protocolos assistenciais ou mesmo a retirada não programada dos dispositivos 4,16 . A literatura mostra que o paciente internado na UTI apresenta maior chance de sofrer EA 54,61,67 .…”