Question 21 from the first paper of 2010 asks the candidate to list the factors predisposing to medication error in ICU, and how to manage them. LITFL have an excellent condensed synopsis of this topic. It draws upon large-scale review articles such as this one and this one.
Medication errors in the ICU
Significance of medication error
- ICU patients have ~ 1.7 medical errors per day
- Of these, ~ 78% are medication errors
- Of these, ~ 54% are errors of medication administration
- Of medication errors in ICU, ~ 20% are lifethreatening, and ~50% lead to the escalation of the level of support.
Causes and predisposing factors
Risk factor |
Management strategy |
Illness severity |
|
Extremes of age |
|
Unexpected admission |
|
Prolonged hospital stay |
|
Doses of drugs which require dosage calculations |
|
Multiple medications |
|
Sedation and decreased participation of the patient |
|
High staff stress, poor nurse-to-patient ratios |
|
Multiple simultaneous care providers |
|
Prevention of medication error in brief summary
- Standardise the medications
- Medication reconciliation (reconciling the list of ICU medications with the normal list of medications which the patient takes at home)
- Computerise dose calculation and infusion devices
- Adequate staffing
- Checklist for drug administration
- Avoid excessive working hours
- Pharmacist participation in ICU care
Management of a medication error
- Full disclosure to the patient and their family
- Documentation the medical record
- Staff councelling and/or education
- Audit of medication error events
- Implementation of evidence-based preventative strategies
References
Moyen, Eric, Eric Camiré, and Henry Thomas Stelfox. "Clinical review: medication errors in critical care." Crit Care 12.2 (2008): 208.
Camiré, Eric, Eric Moyen, and Henry Thomas Stelfox. "Medication errors in critical care: risk factors, prevention and disclosure." Canadian Medical Association Journal 180.9 (2009): 936-943.
Pronovost, Peter, et al. "Medication reconciliation: a practical tool to reduce the risk of medication errors." Journal of critical care 18.4 (2003): 201-205.