Potential adverse drug events: intensive care unit cohort

Authors

DOI:

https://doi.org/10.11606/issn.2176-7262.rmrp.2022.197132

Keywords:

Intensive care units, Drugs monitoring, Pharmacovigilance, Patient safety, Nursing

Abstract

Introduction: Adverse drug events are associated with morbidity and mortality, high hospital stay rates and high costs. Intensive care unit patients are one of the main risk groups for the occurrence of these events. The use of triggers, which indicate potential events, can simplify detection by systematic screening of medical records and enables continuous measurement. Objective: Analyze potential adverse events and correlate their triggers with the length of stay, number of medications, and comorbidities in patients admitted to an adult intensive care unit. Methods: A longitudinal study was conducted with patients admitted to intensive care at high complexity hospital in São Paulo, Brazil. A probabilistic sample consisting of medical records of 83 patients hospitalized, for at least 24 hours, for clinical treatment and who received at least one medication. In the identification of the events the adapted instrument of the Institute for Healthcare Improvement was used, which includes drug, biochemical, and clinical triggers. The Pearson's correlation test was used to correlate the number of triggers with the length of stay, the number of medications, and comorbidities, and the significance of p < 0.05. Results: Antihistamines (43.4%), creatinine increase (50.6%), and lethargy (20.5%) were the most frequent triggers for each category. Among the drugs, acetylsalicylic acid (67%) and omeprazole (55%) were prominent. There was a positive correlation between the total number of triggers and time of hospitalization, the number of medications, and comorbidities (r=0.961, r=0.555, and r=0,210 respectively; p<0.001). Conclusions: Outstanding triggers can be expected for intensive care units’ cardiac patients and suggest warning for professionals involved in monitoring these events.

Downloads

Download data is not yet available.

Author Biographies

  • Vanessa Rossato Gomes, Universidade de São Paulo. Escola de Enfermagem, (SP), Brasil

    Enfermeira, Mestre em Enfermagem

  • Danilo Donizetti Trevisan, Universidade Federal de São João del Rei, Divinópolis, (MG), Brasil

    Doutor em Enfermagem, Professor Adjunto

  • Silvia regina Secoli , Universidade de São Paulo. Escola de Enfermagem, (SP), Brasil

    Doutora em Enfermagem, Professora Associada

References

Ohta Y, Sakuma M, Bates D, Morimoto T. Influence of adverse drug events on the mortality and the length of hospital stay in ICUs in Japan: the JADE Study. Crit Care. 2013;17(Suppl 2):P510. https://dx.doi.org/10.1186/cc12448

Gyllensten H, Hakkarainen KM, Hägg S, Carlsten A, Petzold M, Rehnberg C, Jönsson AK. Economic impact of adverse drug events--a retrospective population-based cohort study of 4970 adults. Plos One. 2014;9(3):e92061. https://dx.doi.org/10.1371/journal.pone.0092061.

González-Méndez MI, López-Rodríguez L. Safety and quality in critical patient care. Enferm Clin. 2017; 27(2):113-117. https://doi.org/10.1016/j.enfcli.2017.02.006

Albayrak A, Başgut B, Bıkmaz GA, Karahalil B. Clinical pharmacist assessment of drug-related problems among intensive care unit patients in a Turkish university hospital. BMC Health Serv Res. 2022;22(1):79. https://doi.org/10.1186/s12913-022-07494-5

Magro L, Arzenton E, Leone R, Stano MG, Vezzaro M, Rudolph A, Castagna I, Moretti U. Identifying and characterizing serious adverse drug reactions associated with drug-drug interactions in a spontaneous reporting database. Front. Pharmacol. 2021;11: 622862. https://doi.org/10.3389/fphar.2020.622862

Lau I, Kirkwood A. Measuring adverse drug events on hospital medicine units with the institute for healthcare improvement trigger tool: a chart review. Can J Hosp Pharm. 2014;67(6):423-428. https://doi.org/10.4212/cjhp.v67i6.1404

Giordani F, Rozenfeld S, Martins M. Adverse drug events identified by triggers at a teaching hospital in Brazil. BMC Pharmacology and Toxicology. 2014;15:71. https://dx.doi.org/10.1186%2F2050-6511-15-71

Cheng YF, Cheng CY, Wang SH, Lin YT, Tsai TC. Use of ICD-10-CM T codes in hospital claims data to identify adverse drug events in Taiwan. J Clin Pharm Ther. 2021;46(2):476-483. https://doi.org/10.1111/jcpt.13308

Härkänen M, Kervinen M, Ahonen J, Voutilainen A, Turunen H, Vehviläinen-Julkunen K. Patient-specific risk factors of adverse drug events in adult inpatients - evidence detected using the Global Trigger Tool method. J Clin Nurs. 2015;24(3-4):582-591. https://dx.doi.org/10.1111/jocn.12714.

Moesker MJ, Schutijser BCFM, Groot JF, Langelaan M, Spreeuwenberg P, Huisman MV, Bruijne MC, Wagner C. Occurrence of Antithrombotic Related Adverse Events in Hospitalized Patients: Incidence and Clinical Context between 2008 and 2016. J Clin Med. 2019;8(6):839. https://doi.org/10.3390/jcm8060839

Laatikainen O, Miettunen J, Sneck S, Lehtini-emi H, Tenhunen O, Turpeinen M. The prevalence of medication-related adverse events in inpatients: a systematic review and meta-analysis. Eur J Clin Pharmacol. 2017; 73:1539-1549. https://doi.org/10.1007/s00228-017-2330-3

Amelung S, Meid AD, Nafe M, Thalheimer M, Hoppe-Tichy T, Haefeli WE, et al. Association of preventable adverse drug events with inpa-tients’ length of stay: a propensity-matched cohort study. Int J Clin Pract. 2017; 71:e12990. https://doi.org/10.1111/ijcp.12990

Poudel DR, Acharya P, Ghimire S, Dhital R, Bharati R. Burden of hospitalizations related to adverse drug events in the USA: a retrospective analysis from large inpatient database. Pharmacoepidemiol Drug Saf. 2017; 26:635-641. https://doi.org/10.1002/pds.4184

Silva MDDG, Martins MAP, Viana LG, Passaglia LG, de Menezes RR, Oliveira JAQ, et al. Evaluation of accuracy of IHI Trigger Tool in identifying adverse drug events: a prospective observational study. Br. J. Clin. Pharmacol. 2018;84(10):2252-2259. https://dx.doi.org/10.1111/bcp.13665

Roque KE, Tonini T, Melo ECP. Eventos adversos na unidade de terapia intensiva: impacto na mortalidade e no tempo de internação em um estudo prospectivo. Cad Saúde Pública. 2016;32(10):e00081815.http://dx.doi.org/10.1590/0102-311X00081815.

Ohta Y, Sakuma M, Koike K, Bates DW, Morimoto T. Influence of adverse drug events on morbidity and mortality in intensive care units: the JADE study. Int J Qual Health Care. 2014;26(6):573-578. https://dx.doi.org/10.1093/intqhc/mzu081.

Latif A, Rawat N, Pustavoitau A, Pronovost PJ, Pham JC. National study on the distribution, causes, and consequences of voluntarily reported medication errors between the ICU and non-ICU settings. Crit Care Med. 2013;41(2):389-398. https://dx.doi.org/10.1097/CCM.0b013e318274156a.

Adler L, Moore J, Federico F. IHI Skilled Nursing Facility Trigger Tool for Measuring Adverse Events. Cambridge (MA): Institute for Healthcare Improvement; 2015.

Rozich JD, Haraden CR, Resar RK. Adverse drug event trigger tool: A practical methodology for measuring medication related harm. Quality and Safety in Health Care. 2003;12:194-200. https://dx.doi.org/10.1136/qhc.12.3.194.

Pandya AD, Patel K, Rana D, Gupta SD, Malhotra SD, Patel P. Global Trigger Tool: Proficient Adverse Drug Reaction Autodetection Method in Critical Care Patient Units. Indian J Crit Care Med. 2020 Mar;24(3):172-178. 0.5005/jp-journals-10071-23367

Brasil. Conselho Nacional de Saúde. Resolução n° 466, de 12 de dezembro de 2012. https://conselho.saude.gov.br/resolucoes/2012/Reso466.pdf

von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP. The strengthening the reporting of observational studies in epidemiology (STROBE) statement: Guidelines for reporting observational studies. International Journal of Surgery, 2014; 12(12), 1495–1499. https://doi.org/10.1016/j.ijsu.2014.07.013

Zimlichman E, Gueta I, Daliyot D, Ziv A, Oberman B, Hochman O, et al. Adverse Drug Event Rate in Israeli Hospitals: Validation of an International Trigger Tool and an International Comparison Study. Isr Med Assoc J. 2018;20(11):665-669. https://www.ima.org.il/FilesUploadPublic/IMAJ/0/313/156940.pdf

Varallo FR, Dagli-Hernandez C, Pagotto C, de Nadai TR, Herdeiro MT, de Carvalho Mastroianni P. Confounding Variables and the Performance of Triggers in Detecting Unreported Adverse Drug Reactions. Clin Ther. 2017;39(4):686-696. https://dx.doi.org/10.1016/j.clinthera.2016.11.005

Hinkle DE, Wiersma W, Jurs SG. Applied Statistics for the Behavioral Sciences. 5th ed. Boston (MA): Houghton Mifflin; 2003

Ribeiro MR, Motta AA, Marcondes-Fonseca LA, Kalil-Filho J, Giavina-BianchiI P. Increase of 10% in the Rate of Adverse Drug Reactions for Each Drug Administered in Hospitalized Patients. Clinics (São Paulo). 2018;73:e185. http://dx.doi.org/10.6061/clinics/2018/e185

Escrivá Gracia J, Brage Serrano R, Fernández Garrido J. Medication errors and drug knowledge gaps among critical-care nurses: a mixed multi-method study. BMC Health Serv Res. 2019;19(1):640. https://doi.org/10.1186/s12913-019-4481-7

Waleed Alhazzani, Fayez Alshamsi, Emilie Belley-Cote, Diane Heels-Ansdell, Romina Brignardello-Petersen, Mustafa Alquraini, et al. Efficacy and safety of stress ulcer prophylaxis in critically ill patients: a network meta-analysis of randomized trials. Intensive Care Med. 2018; 44(1): 1–11. https://dx.doi.org/10.1007/s00134-017-5005-8

Huang HB, Jiang W, Wang CY, Qin HY, Du B. Stress ulcer prophylaxis in intensive care unit patients receiving enteral nutrition: a systematic review and meta-analysis. Crit Care. 2018;22(1):20. https://dx.doi.org/10.1186/s13054-017-1937-1.

Mas-Font S, Ros-Martinez J, Pérez-Calvo C, Villa-Díaz P, Aldunate-Calvo S, Moreno-Clari E. Prevention of acute kidney injury in Intensive Care Units. Med Intensiva. 2017;41(2):116-126. https://dx.doi.org/10.1016/j.medin.2016.12.004.

Khan S, Loi V, Rosner MH. Drug-Induced Kidney Injury in the Elderly. Drugs Aging. 2017;34(10):729-741. https://dx.doi.org/10.1007/s40266-017-0484-4.

Published

2022-11-09

Issue

Section

Original Articles

How to Cite

1.
Gomes VR, Trevisan DD, Secoli S regina. Potential adverse drug events: intensive care unit cohort. Medicina (Ribeirão Preto) [Internet]. 2022 Nov. 9 [cited 2024 May 17];55(3):e-197132. Available from: https://www.periodicos.usp.br/rmrp/article/view/197132