Evaluation of adverse drug reactions in medical intensive care units

Park, Sojin; In, Yongwon; Suh, Gee Young; Sohn, KieHo; Kim, Eun Young

doi:10.1007/s00228-012-1318-2

Cited by 18 publications

(13 citation statements)

References 29 publications

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“…31 Similarly, a study conducted in a medical ICU in Korea by Park et al revealed a positive correlation between patients who developed ADRs and their length of hospital stay. 32 Dissimilar finding was also seen in a longitudinal observational study (4.2 days vs. 3.9). 33 A positive correlation was established between the number of drugs (polypharmacy) and occurrence of ADRs which was found to be statistically significant (p< 0.01).…”

Section: Discussionsupporting

confidence: 56%

Monitoring and Reporting of Adverse Drug Reactions Due to Cardiovascular Drugs in Patients Admitted to a Secondary Care Hospital in Northern Emirate- a Prospective Surveillance Study

Wadhwa¹,

Sheikh²,

Rao³

2018

IJOPP

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Context: Adverse drug reactions (ADRs) can result in a number of consequences, ranging from allergic reactions to permanent harm thereby causing morbidity and mortality leading to an increase in the health care costs. Aims: The main objective of the present study was to assess the prevalence of adverse drug reactions due to cardiovascular drugs in patients admitted to a secondary care hospital. Material and Methods: This was a prospective surveillance study which included adult patients of either gender who were hospitalized and prescribed with at least one cardiovascular drug. Patients were monitored from the day of admission till the day of discharge for the occurrence of ADRs due to cardiovascular drugs by attending clinical meetings, ward rounds, reviewing patients' medical records and electronic medical records. Results: A total of 309 patients were enrolled in the present study. Among them, 72 patients experienced 109 ADRs accounting for an incidence of 23.3%. Twelve (3.88%) patients were hospitalized due to ADRs (n=16) whereas 60 (19.41%) patients developed ADRs (n=93) during their hospital stay. Male preponderance was observed over female. Patients with age ≥ 60 years experienced 73 ADRs. The most common drug class implicated in ADRs was observed to be beta blockers (18; 16.5%) especially bisoprolol (16; 14.68%). Majority of patients experienced bradycardia (11; 10.09%) followed by hypotension (9; 8.26%). Cardiovascular system (30; 27.53%) was observed to be the most common system. Majority of ADRs were possible (80; 73.39%) in nature, mild (53%) in severity and not preventable (84.5%). Conclusion: Intensive approach towards monitoring and reporting of ADRs could help healthcare professionals in minimizing preventable ADRs.

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Section: Discussionsupporting

confidence: 56%

Monitoring and Reporting of Adverse Drug Reactions Due to Cardiovascular Drugs in Patients Admitted to a Secondary Care Hospital in Northern Emirate- a Prospective Surveillance Study

Wadhwa¹,

Sheikh²,

Rao³

2018

IJOPP

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“…[8, 9] Others report similar adverse effects of excessive empirical antibiotics in the ICU. [14–17, 25–32] Our study supports these prior findings by demonstrating that each one day increase in empirical antibiotic duration is associated with a 14% relative increase in risk-adjusted mortality, and that fewer empirical antibiotics are not associated with worse clinical outcome.…”

Section: Discussionsupporting

confidence: 84%

A Clinical Trial Comparing Physician Prompting With an Unprompted Automated Electronic Checklist to Reduce Empirical Antibiotic Utilization

Weiss

DiBardino

Rho

et al. 2013

Critical Care Medicine

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Objective To determine whether face-to-face prompting of critical care physicians reduces empirical antibiotic utilization compared to an unprompted electronic checklist embedded within the electronic health record (EHR). Design Random allocation design. Setting Medical intensive care unit (MICU) with high-intensity intensivist coverage at a tertiary care urban medical center. Patients Two hundred ninety-six critically ill patients treated with at least one day of empirical antibiotics. Interventions For one MICU team, face-to-face prompting of critical care physicians if they did not address empirical antibiotic utilization during a patient’s daily rounds. On a separate MICU team, attendings and fellows were trained once to complete an EHR-embedded checklist daily for each patient, including a question asking whether listed empirical antibiotics could be discontinued. Measurements and main results Prompting led to a more than 4-fold increase in discontinuing or narrowing of empirical antibiotics compared to use of the electronic checklist. Prompted group patients had a lower proportion of patient-days on which empirical antibiotics were administered compared to electronic checklist group patients (63.1% vs. 70.0%, P=0.002). Mean proportion of antibiotic-days on which empirical antibiotics were used was also lower in the prompted group, although not statistically significant (0.78 [0.27] vs. 0.83 [0.27], P=0.093). Each additional day of empirical antibiotics predicted higher risk-adjusted mortality (odds ratio 1.14, 95% CI 1.05–1.23). Risk-adjusted ICU length of stay and hospital mortality were not significantly different between the two groups. Conclusions Face-to-face prompting was superior to an unprompted EHR-based checklist at reducing empirical antibiotic utilization. Sustained culture change may have contributed to the electronic checklist having similar empirical antibiotic utilization to a prompted group in the same MICU two years prior. Future studies should investigate the integration of an automated prompting mechanism with a more generalizable EHR-based checklist.

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“…Tal es el caso de una unidad de cuidados intensivos de adultos en la que los médicos identificaron y anotaron en el expediente el 70% de las RAM que presentaron sus pacientes 24 . En el caso de pacientes pediátricos, Neubert y colaboradores realizaron un estudio en el que se revisó el expediente clínico por un equipo de expertos (Farmacólogo Clínico, Farmacéutico y Pediatra) como estándar de oro, y encontraron que los médi-cos reconocieron el 50% de las RAM que se presentaron en los niños internados en ese hospital pediátrico 12 .…”

Section: Discussionunclassified

¿Los pediatras detectan las reacciones adversas a medicamentos aunque no las reporten?

Morales-Ríos

Jasso-Gutiérrez

Garduño-Espinosa

et al. 2015

Boletín Médico del Hospital Infantil de México

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Evaluation of adverse drug reactions in medical intensive care units

Cited by 18 publications

References 29 publications

Monitoring and Reporting of Adverse Drug Reactions Due to Cardiovascular Drugs in Patients Admitted to a Secondary Care Hospital in Northern Emirate- a Prospective Surveillance Study

Monitoring and Reporting of Adverse Drug Reactions Due to Cardiovascular Drugs in Patients Admitted to a Secondary Care Hospital in Northern Emirate- a Prospective Surveillance Study

A Clinical Trial Comparing Physician Prompting With an Unprompted Automated Electronic Checklist to Reduce Empirical Antibiotic Utilization

¿Los pediatras detectan las reacciones adversas a medicamentos aunque no las reporten?

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