Adverse-drug-event rates for high-cost and high-use drugs in the intensive care unit.
OBJECTIVE
The rates of adverse drug events (ADEs) associated with high-cost and high-use drugs in the intensive care unit (ICU) were studied.


METHODS
This retrospective analysis was conducted from October 1997 through June 2001 in a 647-bed academic medical center with over 120 ICU beds. Adult patients with a documented ADE occurring in the ICU were included in the analysis. ADE information, including suspected medication, causality, preventability, and severity, was extracted from the institutional ADE database. Published definitions of ADEs and published scales for causality and severity assessments were used. High-cost medications were those in the top 50% of cumulative ICU medication costs, and high-use medications accounted for the upper 50% of all medications used in the ICU. Between-group comparisons of ADE rates, preventability, and severity associated with high-cost and high-use medications were conducted.


RESULTS
Of the 17 medications that were considered high cost, 9 (53%) were associated with ADEs. Of the 15 medications that met the criteria for high-use drugs, 12 (80%) were associated with ADEs. The rates of ADEs associated with high-cost and high-use drugs did not significantly differ (43% versus 75%, respectively; p = 0.098). ADEs associated with high-cost and high-use medications were categorized as mild (15% versus 10%, respectively), moderate (52% versus 50%, respectively), and severe (33% versus 40%, respectively) (p > 0.05).


CONCLUSIONS
The frequency, severity, and preventability of ADEs in the ICU were not associated with a drug's cost or frequency of use. Monitoring priorities of the critical care pharmacist should not be dictated by cost alone but should include frequency of use and the potential for causing an ADE.
Kane-Gill
Sandra
S
Department of Pharmacy and Therapeutics, Center for Pharmacoinformatics and Outcomes Research, School of Pharmacy, University of Pittsburgh, PA 15261, USA. kansl@upmc.edu
Rea
Rhonda S
RS
Verrico
Margaret M
MM
Weber
Robert J
RJ
D016527:Drug Costs; D004363:Drug Utilization; D064420:Drug-Related Side Effects and Adverse Reactions; D005260:Female; D006746:Hospital Bed Capacity, 500 and over; D006785:Hospitals, University; D006801:Humans; D007362:Intensive Care Units / Q000191:economics / Q000458:organization & administration*; D008297:Male; D008875:Middle Aged; D004364:Pharmaceutical Preparations / Q000191:economics*; D012189:Retrospective Studies
D004364:Pharmaceutical Preparations