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US Pharm. 2006;5:56-59.
Intensive care units (ICUs) are one of the most expensive components of U.S. health care, representing 10% of acute care beds yet comprising approximately 30% of acute care costs. 1-3
Patient care in ICU areas is complex, in part because of the broad scope of acute illnesses and preexisting conditions present among ICU patients.
During the five-year period 2000 through 2004, more than 38,000 error reports were submitted to USP's MEDMARX program by 503 facilities for error events that occurred primarily in adult ICU areas.
A little over 7% (n = 2,819) of the ICU medication errors were categorized as potential errors, whereas 89.3% (n = 34,282) were nonharmful and 3.3% (n = 1,270) resulted in some level of patient harm. Among the harmful errors, 83.7% (n = 1,063) resulted in temporary harm, whereas 68 were sentinel events including 14 fatalities.
Nearly half of the medication errors originated in the Prescribing and Transcribing/ Documenting nodes (i.e., phases) of the medication use process (Table 1). Errors originating in the Administering node represented the largest percentage of actual errors (42.5%), the largest percentage of harmful errors (61.1%), and the largest percentage of sentinel events (57.4%). Errors originating in the Prescribing node resulted in the second highest percentage of sentinel events (29.4%), a result that is disproportionately high considering the small number (n = 168) of harmful errors in the Prescribing node.
Combining related but somewhat infrequent causes of error identified several common problems. Intravenous (IV) pumps and other equipment were cited a total of 1,237 times, of which 10.8% were harmful. Causes related to drug product packaging/labeling were cited a combined total of 949 times, of which 7.4% were harmful. Six communication-related causes totaled 5,021 selections, of which 5.4% were associated with harm. The use of IV pumps and other medical equipment is more extensive within ICUs than in most other patient care areas. The percentage of harm associated with errors involving pumps/equipment, drug packaging/labeling, and communication point to problem areas that warrant further attention.
Recommendations to Improve Safety
The complexity of ICUs, combined with the high acuity of the patients treated in these areas, creates an environment that is more susceptible to harmful patient outcomes when medication errors occur. The Agency for Healthcare Research and Quality (AHRQ) Evidence Report/Technology Assessment --Making Healthcare Safer: A Critical Analysis of Patient Safety Practices, identified several interventions that can reduce mortality in ICU patients.4 These include the following: reporting adverse events; staffing ICUs with physicians trained in critical care (i.e., intensivists); improving communication and the culture of safety among caregivers; and controlling blood glucose in critically ill patients. Other approaches to minimizing medication errors in ICUs include the following:
1. Assigning a dedicated pharmacist to ICU areas.
2. Implementing a CPOE and bar-code system.
3. Reducing medical residents' work hours.
4. Ensuring adequate patient/staffing patterns.
5. Simplifying and standardizing IV pumps, monitors, and IV catheters.
6. Allowing adequate input on and training for new technology (e.g., IV pumps).
This article represents a small portion of data and information contained in USP's most recent MEDMARX Data Report: A Chartbook of 2000–2004 Findings from Intensive Care Units and Radiological Services. Complete data findings related to medication errors in these clinical areas can be obtained online at www.usp.org/ products/medMarx.
REFERENCES
1. Joint position statement: Essential provisions for critical care in health system reform. Society of Critical Care Medicine. American Association of Critical Care Nurses. Crit Care Med. 1994;22(12):2017-2019.
2. Groeger JS, Guntupalli KK, Strosberg M, et al. Descriptive analysis of critical care units in the United States: patient characteristics and intensive care unit utilization. Crit Care Med. 1993;21(2):279-291.
3. Halpern NA, Bettes L, Greenstein R. Federal and nationwide intensive care units and healthcare costs: 1986-1992. Crit Care Med. 1994;22(12):2001-2007.
4. Shojania KG, Duncan BW, McDonald KM, et al. Making health care safer: a critical analysis of patient safety practices. Agency for Healthcare Research and Quality, Evidence Report/Technology Assessment: Number 43. Rockville, MD. 2001;(43): i-x, 1-668.
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