Affiliations: Department of Pharmacy Practice & Science,
College of Pharmacy, University of Arizona, Tucson, AZ, USA | Department of Pharmacy Practice, Midwestern
University, College of Pharmacy, Glendale, AZ, USA
Note: [] Corresponding author: Brian L. Erstad, Pharm. D., The University
of Arizona College of Pharmacy, Department of Pharmacy Practice &
Science, 1295 N. Martin, PO Box 210202, Tucson, AZ 85721-0207, USA. Tel.: +1
520 694 5600; Fax: +1 520 626 7355; E-mail: [email protected]
Abstract: Critically ill patients are at the greatest risk of experiencing
preventable and non-preventable adverse drug events (ADEs) compared to other
patient populations. Information on ADEs concerning these patients is derived
from a wide spectrum of sources such as surveillance studies involving large
databases to landmark clinical investigations. Historically there has been a
lack of consistency with regard to definitions of commonly used terms such as
medication error, ADE, and preventability, which is a fundamental to
appropriately conduct and interpret results of epidemiological investigations
in this setting. However, attempts have been made to standardize this
terminology by national organizations. The increased risk of ADEs in the
critically ill patient population is due to a variety of reasons, which include
the routine use of the intravenous route of drug administration, medications
with a low therapeutic index and high complexity, 'off-label' use and an
environment that may be conducive to errors. Reporting of ADEs is largely
voluntary and is generally underreported and skewed towards the most serious
events. Other methods for surveillance of ADEs in the critical care setting
include medical record review and direct observation. Each of these methods has
their own limitations and the data obtained can vary depending on the method
used. A combination of data from all of these methods is likely to produce the
most comprehensive information to improve patient safety.
Keywords: Critical care, pharmacoepidemiology, adverse drug events
