An exploratory analysis of medication utilization in a medical intensive care unit.

OBJECTIVES

To evaluate patterns of medication use in a medical intensive care unit (ICU) and to explore relationships between drug use, patient age, admitting diagnosis, Acute Physiology and Chronic Health Evaluation (APACHE II) scores, length of stay, and survival.

DESIGN

Combination prospective and retrospective study.

SETTING

Medical ICU in a large teaching institution.

PATIENTS

Patient admissions (n = 191) to a medical ICU during a 4-month study period.

INTERVENTIONS

The following data were collected: age, length of stay, diagnosis, physiologic variables necessary for APACHE II scores, medications administered, and survival.

MEASUREMENTS AND MAIN RESULTS

The mean length of stay of the study patients was 5.2 +/- 9.8 days. Overall mortality rate was 33%. The mean age of survivors, 62.7 yrs, was significantly (p < .05) lower than that value for nonsurvivors (68.6 yrs). Postcardiopulmonary resuscitation (CPR) or -stroke patients had a mortality rate that was higher than the overall mortality rate (p < .05). APACHE II scores of > 19 were associated with a reduced survival rate when compared with the overall mortality rate. The mean daily and mean total number of medications administered per patient were 7.5 +/- 3.4 and 12.1 +/- 7.6, respectively. Antihypertensives/vasodilators and gastrointestinal prophylaxis medications were administered most commonly in 69% and 65% of patients, respectively. The median total drug use per patient was significantly greater in nonsurvivors vs. survivors (13 and 10, respectively, p < .02). There was a positive linear relationship between total medication use and log length of stay (r2 = .62). Patients admitted post-CPR or with seizures received the highest number of medications (p < .05).

CONCLUSIONS

Patients admitted to the medical ICU receive multiple medications from a variety of pharmacologic classes. Prolonged length of stay, certain admitting diagnoses, and death are associated with increased medication administration. Age, certain admitting diagnoses, and APACHE II scores are significantly related to survival.