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Adverse drug events in intensive care units: Risk factors, impact, and the role of team care

Kane-Gill, Sandra L. PharmD, MSc, FCCM, FCCP; Jacobi, Judith PharmD, FCCM, FCCP, BCPS; Rothschild, Jeffrey M. MD, MPH

doi: 10.1097/CCM.0b013e3181dd8364
Article

Advances in diagnostic tests, technological interventions, and pharmacotherapy have resulted in spectacular results for many intensive care unit (ICU) patients who, in earlier generations, would have succumbed to their critical illness. At the same time, the complexity and intensity of care required for ICU patients is also associated with greater risks for harm resulting from care. As in other inpatient areas, medications are the most common type of therapy in ICUs and are also associated with the most frequent type of ICU adverse events. Critically ill patients are at high risk for adverse drug events for many reasons, including the complexity of their disease that creates challenges in drug dosing, their vulnerability to rapid changes in pharmacotherapy, the intensive care environment providing ample distractions and opportunity for error, the administration of complex drug regimens, the numerous high-alert medications that they receive, and the mode of drug administration. The clinical outcomes of adverse drug events can result in end-organ damage and even death. The costs of an adverse drug event can be substantial to healthcare systems with an additional $6,000–$9,000 for each event. The multiprofessional patient care team is one approach to promoting patient safety in the ICU.

From the School of Pharmacy (SLK-G), Center for Pharmacoinformactics and Outcomes Research, University of Pittsburgh, Pittsburgh, PA; Department of Pharmacy, University of Pittsburgh Medical Center, Pittsburgh, PA; Methodist Hospital/Clarian Health (JJ), Indianapolis, IN; and the Division of General Medicine and Primary Care (JMR), Department of Medicine, Brigham and Women's Hospital, Boston, MA; and Harvard Medical School (JMR), Boston, MA.

The authors have not disclosed any potential conflicts of interest.

For information regarding this article, E-mail: SLK54@pitt.edu

© 2010 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins