Safe Drug Use in Critically Ill Patients

Overview of Medication Errors and Adverse Drug Events Medication errors (MEs) are the most common type of medical error occurring in the intensive care unit (ICU). The definitions and incidence rates for MEs and types of adverse drug events (ADEs) are listed in Table 1-1. Medication errors may result in patient injury, but this is not a requirement to be considered an error. Clinicians strive to reduce MEs to avoid the possibility of injury, referred to as a preventable ADE. Data from a study performed in a medical and coronary ICU indicate that about one-fourth of MEs result in an ADE. This proportion varies with the definition of injury, which is not clearly described in many ADE investigations. An injury could be as benign as a transient abnormal laboratory value or a rash; conversely, it could be as significant as end-organ damage. This definition of injury associated with a drug requires clarification in the literature. Potential ADEs (or near misses) are MEs that could result in injury but that do not. The most common example of a potential ADE involves the patient who, despite a documented allergy to penicillin, receives a dose of this drug but does not have an anaphylactic reaction. Several MEs may occur without producing an ADE. The converse is also true: ADEs are not always the result of an ME. Such an event is referred to as a nonpreventable ADE. This chapter discusses safe drug use in both ICU and emergency department (ED) patients.