Purpose: Patients in the intensive care unit (ICU) are at an increased risk for medication errors (MEs) and adverse drug events from multifactorial causes. ME rate ranges from 1.2 to 947 per 1,000 patient days in the medical ICU (MICU). Studies with the implementation of electronic health records (EHR) have concluded that it significantly reduced overall prescribing errors and the number of errors that caused patient harm decreased. However, other types of errors, such as wrong dose and omission of required medications increased after EHR implementation. We sought to compare the number of MEs before and after EHR implementation in the MICU, with additional evaluation of error severity.
Patients and methods: Prospective, observational, quality improvement study of all patients admitted to a single MICU service at an academic medical center. Patients were evaluated during four periods over 2 years: August–September 2010 (preimplementation; period I), January–February 2011 (2 months postimplementation; period II), August–September 2012 (21 months postimplementation; period III), and January–February 2013 (25 months postimplementation; period IV). All medication orders and administration records were reviewed by an ICU clinical pharmacist and ME was defined as a deviation from established standards for prescribing, dispensing, administering, or documenting medication. The frequency and classification of MEs were compared between groups by chi square; p<0.05 was considered significant.
Results: There was a statistically significant increase in the number of MEs per 1,000 patient days during time periods II (N=2,592; p<0.001) and III (N=2,388; p=0.0023) compared to baseline (N=1,972). However, over time there was a significant reduction in medication errors during period IV compared to baseline (N=1,669; p=0.0008).
Conclusion: In the short-term, EHR did not lead to a reduction in medication errors in the ICU; however, there was a significant decrease in medication errors after 2 years.
Drotrecogin alfa was introduced in 2001 as a treatment for severe sepsis following the results of the PROWESS trial; however, in October of 2011 drotrecogin alfa was re moved worldwide due to a lack of survival benefit demonstrated in the PROWESS-SHOCK trial. There is limited literature describing the outcomes seen outside of the controlled research environment with drotrecogin alfa.
Objective:
The purpose of this study was to describe the outcomes of patients treated with drotrecogin alfa in clinical practice at an urban safety net hospital.
Methods:
A retrospective analysis was conducted on all patients that received drotrecogin alfa from January 2002 to April 2008. The primary outcome was 28-day mortality in all patients. Baseline patient characteristics and 28-day mortality were compared to those found in the PROWESS trial.
Results:
In the current study, 59.5% expired before 28 days which was significantly higher than the 24.7% mortality rate found in PROWESS (p < 0.0001). However, patients in the current study were more ill than those found in PROWESS as shown by
the average APACHE II score in the current study being 28.2 versus 24.6 in PROWESS (p < 0.0001). Patients with HIV had the highest 28-day mortality rate of 77% while patients that were obese had the lowest 28-day mortality rate of 33.3%.
Conclusions:
Patients treated with drotrecogin alfa in clinical practice tended to have a higher mortality rate than those patients treated in the PROWESS study. However, patients in the current study tended to be more ill than those in PROWESS.