Principles and Practices of Medication Safety in the ICU
Section snippets
Prevalence
The prevalence of medication errors in the ICU varies widely; a full review of the literature is summarized in Table 1. For comparison purposes the prevalence rates were changed to number of errors per 1000 patient-days when possible. The frequency of medication errors ranged from 1.2 to 947 per 1000 patient-days with a median of 105.9 per 1000 patient-days in adult ICUs and 24.1 per 1000 patient-days in neonatal/pediatric ICUs [14], [16], [17], [18]. The large variation in error rates can be
The medication process
The medication use process has been categorized into several pivotal nodes (or functions), including ordering/prescribing, transcribing/documenting, dispensing, administering, and monitoring [3], [21], [25], [26]. Evaluating the medication use process by incorporating these nodes allows for a systematic analysis. For example, information may be used to identify the node with the most errors and areas of opportunity for improvement. The prescribing and administration nodes are associated with
Methods of medication error detection
Submission of a voluntary or solicited incident report is the most common method of detecting medication errors. The characteristics of an effective voluntary reporting system are anonymity, ease of use, and ability to generate information to determine the cause of errors. These characteristics are shared by the Institute for Safe Medication Practices Medication Error Reporting Program and The USP MEDMARX system [39].
The second method of detecting medication administration errors is through
Intensive surveillance programs
Intensive surveillance programs that include methods of identification, such as voluntary reporting, solicitation of error information from persons involved in the medication use process, direct observation, and chart/medication administration record review, are an optimal approach to error identification because these methods uncover different types of errors [43]. Voluntary reporting alone usually does not yield an optimal rate of reporting. Implementing “no blame” policies, incentive
Summary
Medication errors occur frequently in the ICU and can result in patient harm. Many medication errors are preventable, and steps can be taken to reduce their frequency. Intensive surveillance programs should exist at every institution to identify, report, and analyze medication errors. A better understanding of the potential risks and common sources of medication errors can contribute to developing systems for their prevention in the ICU. There is a need to use common definitions so that error
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