List the factors predisposing to medication error in ICU. How can these be minimised?
Answer and interpretation
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.
- Severity of illness
- Extremes of age
- Prolonged hospitalisation
- Sedation, patient unable to tell nurse medication wrong.
- 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.
- 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)
- 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.