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


METHODS
Combination prospective and retrospective study.


METHODS
Medical ICU in a large teaching institution.


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


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


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.
Smythe
M A
MA
Department of Pharmacy Practice, Wayne State University, Detroit, MI 48202.
Melendy
S
S
Jahns
B
B
Dmuchowski
C
C
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000959:Antihypertensive Agents / Q000627:therapeutic use; D002561:Cerebrovascular Disorders / Q000188:drug therapy / Q000401:mortality; D003953:Diagnosis-Related Groups; D004358:Drug Therapy / Q000145:classification / Q000706:statistics & numerical data*; D004363:Drug Utilization; D005260:Female; D005765:Gastrointestinal Agents / Q000627:therapeutic use; D006784:Hospitals, Teaching / Q000706:statistics & numerical data; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D007902:Length of Stay / Q000706:statistics & numerical data; D016014:Linear Models; D008297:Male; D008824:Michigan; D008875:Middle Aged; D010343:Patient Admission / Q000706:statistics & numerical data; D011446:Prospective Studies; D012189:Retrospective Studies; D012640:Seizures / Q000188:drug therapy; D012720:Severity of Illness Index; D015996:Survival Rate; D014665:Vasodilator Agents / Q000627:therapeutic use
D000959:Antihypertensive Agents; D005765:Gastrointestinal Agents; D014665:Vasodilator Agents