ADEs

Q: Adverse Drug Events (ADEs) are more common in? - Select one

A) Outpatient

B) Emergency Room(ER)

C) Inpatient Ward

D) ICU 

Answer: D

Studies have shown that ICU is the most common place to have ADEs, particularly during night shifts and on weekends. Some of the primary reasons for these mishaps are:

1. ICU patients usually receive more medications than in other medical settings.

2. Many medications are new, and patients' profiles are not yet documented for drug-drug interactions.

3. Most medications in the ICU are given intravenously (IV), which can lead to higher reactions and miscalculations of doses/infusion rates. 

4. ICU patients have multiple severe comorbidities.

5. ICU patients are often sedated and can't check/question/report their own drugs.

6. Upon arrival in the ICU, long-term and often essential drugs are frequently held or discontinued, such as antiplatelets in stent patients or anticoagulants in atrial fibrillation or thrombus patients.

7. In ICUs, patients' levels of care remain the same during night shifts and on weekends, but there is less staffing and supervision.

#pharmacology

#patient-safety

References:

1.Wilmer A, Louie K, Dodek P, et al. Incidence of medication errors and adverse drug events in the ICU: a systematic review. Qual Saf Health Care 2010; 19:e7.

2. Kane-Gill S, Weber RJ. Principles and practices of medication safety in the ICU. Crit Care Clin 2006; 22:273.

3. Bell CM, Brener SS, Gunraj N, et al. Association of ICU or hospital admission with unintentional discontinuation of medications for chronic diseases. JAMA 2011; 306:840.

4. Miller AD, Piro CC, Rudisill CN, et al. Nighttime and weekend medication error rates in an inpatient pediatric population. Ann Pharmacother 2010; 44:1739.