Calabrese, A. D., Erstad, B. L., Brandl, K., Barletta, J. F., Kane, S. L., & Sherman, D. S. (2001). Medication administration errors in adult patients in the ICU. Intensive Care Medicine, 27(10), 1592-1598.
PMID: 11685299;Abstract:
Objective: To quantify the incidence and specify the types of medication administration errors from a list of error-prone medications and to determine if patient harm resulted from these errors. Design: An observational evaluation. Setting: Five intensive care units (ICUs) in the United States. Patients and participants: Eight hundred fifty-one patients who were at least 18 years of age and admitted to surgical, medical or mixed ICUs during a 3 month period were included. Interventions: None. Measurements and results: A list of error-prone medications was adapted from the literature and evaluated for medication errors and patient harm. Of 5,744 observations in 851 patients, 187 (3.3%) medication administration errors were detected the therapeutic classes most commonly associated with errors were vasoactive drugs 61 (32.6%) and sedative/analgesics 48 (25.7%). The most common type of error was wrong infusion rate with 71 (40.1%) errors. Twenty-one errors did not reach the patient and 159 reached the patient but did not result in harm, increased monitoring or intervention. Five errors required increased patient monitoring and two required intervention. None of the errors resulted in patient death. Conclusions: This multicenter evaluation found fewer medication administration errors than the published literature, possibly due to the varying observational techniques and pharmacist involvement. Lorazepam and wrong infusion rates are associated with errors that occurred frequently, resulted in the greatest potential for harm and were common oversights in the system. These errors should be considered potential areas for betterment in the medication use process to improve patient safety.
Erstad, B. L. (2003). Osmolality and osmolarity: Narrowing the terminology gap. Pharmacotherapy, 23(9 I), 1085-1086.
Jacques, K. A., & Erstad, B. L. (2010). Availability of information for dosing injectable medications in underweight or obese patients. American Journal of Health-System Pharmacy, 67(22), 1948-1950.
PMID: 21048212;Abstract:
Purpose. Product information and pivotal studies on newly marketed injectable medications were reviewed to determine whether a weight descriptor was included and if information was provided for dosing patients with extremes of body weight. Methods. Products with new drug applications approved by the Food and Drug Administration between January 1, 2004, and January 30, 2009, were evaluated. Any information related to weight descriptors or dosing of patients with extremes of weight (body mass index of 18.5 or >40 kg/m2) relative to age and height was extracted from the product labeling or pivotal studies. Pharmaceutical companies were contacted if pivotal studies had not been published. The information was evaluated with a dosing usefulness score of 0-3; a score of 2 or greater was considered minimally adequate for dosing patients with extremes of weight. Results. Of the 84 medications evaluated, some reference to weight descriptors was found for 23 (27%). None had a calculated usefulness score of 2 or above based on information from product information or pivotal trials. Conclusion. Information from product labeling and pivotal studies involving newly marketed injectable medications is inadequate for dosing patients with extremes of weight.
