CICM SAQ 2010.1 Q21

Note to examiners: This is a very broad question. The following is an example of a good answer to this question. It is expected that there will be a range of different answers by candidates. No breakdown has been provided for the marks. Examiners are urged to use their discretion and should award marks to all reasonable answers.

Factors predisposing

Patient factors

• Severity of illness
• Extremes of age
• Prolonged hospitalisation
• Sedation, patient unable to tell nurse medication wrong.

Medication errors

• Types of medications are infusions or weight based or programmed if an infusion pump is required.
• Number of medications, more than on the ward
• Number of interventions therefore increased risk of complications.

ICU environment

• Complex environment – high stress, high turnover, high nursing turnover.
• Emergency admission
• Multiple care providers

Minimisation of medication errors

Optimise medication process

• Medication standardisation
• Computerised physician order entry
• Barcode technology
• Computerised infusion device
• Medication reconciliation

Eliminate situational factors

• Avoid excessive consecutive and cumulative working hours
• Minimise interrupts and distractions
• Trainee supervision and graduated responsibility

Oversight and error interception

• Primary doctor in charge of all drugs ( intensivist)
• Adequate staffing
• Pharmacist participation
• Quality assurance as part of education program. ( Evidence of adverse drug events dropping by 66% with pharmacist involvement, results in reducing length of stay, decreasing mortality and medication expenditure)

Nursing/Patient ratio

• If increased patient/ nurse ratio, increasing error.
• Mention AIMS ICU (Australian incident monitoring study in Intensive Care) has been developed with goal of balancing strengths with limitations of error reporting.