Adverse Drug Events at the Intensive Care Unit

Adverse drug events are among the most common in the intensive care unit (ICU) and they are linked to increased morbidity, costs and mortality. ICU patients require complex and intense care procedures. This could also be a source of greater risks due to increased nurse workload. In the ICU, medication is the most common form of intervention for many patients and therefore related to frequent cases of ICU adverse events (Kane-Gill, Jacobi, & Rothschild, 2010).

In most cases, seriously ill patients are at high risks for adverse drug events (ADEs) because of several reasons. The intense and complex nature of medication could contribute to drug dosing, swift reactions to pharmacotherapy, susceptibility in the ICU environment creates opportunities for errors, complexity in drug regimens, many high responsive drugs and methods of drug administration have contributed to ADEs among patients in ICUs (Kane-Gill et al., 2010).

Detection

Various studies have shown that their different methods of detecting ADEs among patients in ICUs. These modes of detecting ADEs could yield different outcomes based on their effectiveness and applications.

Kane-Gill et al. (2011) noted that there are clinical event monitors, which are generally for active medication monitoring to detect and inform physicians regarding potential ADEs. Computerised clinical event monitoring systems have provided positive outcomes in detecting ADEs. They are a part of ICU patient safety surveillance approaches. These systems provide automated detection and alerts by reviewing laboratory and medication data.

Kane-Gill, Kirisci, Verrico and Rothschild (2012) observed that a comprehensive chart review method could not capture all ADEs. That is, different detection methods are most likely to yield different outcomes. Spontaneous reporting systems were more effective than the comprehensive chart reviews particularly in administration of related ADEs. Some detection approaches require substantial resources and time.

Anthes, Harinstein, Smithburger, Seybert, and Kane-Gill (2013) aimed to investigate the frequency and types of ADEs noted in ICU transfer summaries and hospital discharge summaries to show the effectiveness of detection mechanisms. The authors concluded that the use of ICU transfer summaries to detect ADEs was an effective approach. As a result, hospitals should consider the use of ICU transfer summary in their ICUs as an additional way of supporting any other existing ADE detection systems for improved pharmacovigilance (Anthes et al., 2013).

According to Call et al. (2014), many medication-based triggers provided low positive predictive values (PPVs). Hence, it is imperative to review and refine triggers depending on patients’ conditions and drug usage patterns to enhance the PPVs and ensure that they are useful for quality enhancement. Call et al. (2014) concluded that effective detection of ADEs required triggers that show “specialised paediatric patient populations such as haematology and oncology patient” (p. 447).

Other hospitals have relied on voluntary reporting to identify cases of adverse effects (Lemon & Stockwell, 2012). However, this method has not been effective in some instances. Lemon and Stockwell (2012) observed that electronic health records (EHRs) have useful clinical data that could be analysed to identify patients who were at greater risks of adverse events. Outcomes could be used to enhance adverse events detection. Effective adoption of an automated trigger system that is attached to EHRs could detect systematic issues with high-risk medications in an efficient and cost-effective manner. Lemon and Stockwell (2012) concluded that it was imperative to develop an automated adverse event detection system.

References

Anthes, A., Harinstein, L., Smithburger, P., Seybert, A., & Kane-Gill, S. (2013). Improving adverse drug event detection in critically ill patients through screening intensive care unit transfer summaries. Pharmacoepidemiology and Drug Safety, 22(5), 510–516. Web.

Call, R., Burlison, J., Robertson, J., Scott, J., Baker, D., Rossi, M.,… Hoffman, J. (2014). Adverse Drug Event Detection in Pediatric Oncology and Hematology Patients: Using Medication Triggers to Identify Patient Harm in a Specialized Pediatric Patient Population. The Journal of Pediatrics, 165(3), 447-452.e4.

Kane-Gill, S. L., Jacobi J., & Rothschild, J. M. (2010). Adverse drug events in intensive care units: risk factors, impact, and the role of team care. Critical Care Medicine, 38(6 Suppl), S83-9. Web.

Kane-Gill, S., Kirisci, L., Verrico, M., & Rothschild, J. (2012). Analysis of risk factors for adverse drug events in critically ill patients. Critical Care Medicine, 40(3), 823–828. Web.

Kane-Gill, S., Visweswaran, S., Saul, M., Wong, A-K., Penrod, L., & Handler, S. (2011). Computerized detection of adverse drug reactions in the medical intensive care unit. International Journal of Medical Informatics, 80(8), 570– 578. Web.

Lemon, V., & Stockwell, C. (2012). Automated detection of adverse events in children. Pediatric Clinics of North America, 59(6), 1269-78. Web.