Understanding and mitigating medication errors associated with patient harm in adult intensive care units: a scoping review.

PURPOSE

Medication interventions are fundamental to the care of the critically ill patient in the intensive care unit (ICU), relying on effective and appropriate delivery of the medication use process. Medication errors affect a high proportion of patients in the ICU. This scoping review maps the literature pertaining to medication errors and preventable adverse drug events in the adult ICU.

METHODS

We searched seven electronic databases (PubMed, MEDLINE, EMBASE, CINAHL, Web of Science, Cochrane, Google Scholar), identifying 2960 records. After screening against predefined eligibility criteria, 48 records were included for data extraction.

RESULTS

A high variation in incidence of medication errors and preventable adverse drug events were reported, reflecting the heterogeneity in study designs, surveillance methods and preventability assessments. Associated risks factors include patient (high severity of illness, older age), clinical (renal dysfunction, prolonged ICU stay), staff (staff inexperience, role overload), environmental (interruptions, transfer of care) in addition to high-risk medications. The rate of serious or life-threatening harm was low at 1-5% of all medication errors. Half (n = 11, 55%) of the interventions or mitigation practices were focused on the medication prescription phase.

CONCLUSION

Most medication errors in ICU are identified and intercepted by systems and staff. A minority lead to preventable patient harm and increased length of stay. Decision support embedded in e-prescribing systems, medication reconciliation and review processes and clinical pharmacist activities reduce medication errors and patient harm.