Medication Safety Alerts

Abstract

Pharmacologic therapy for agitation or anxiety is a mainstay in the intensive care unit (ICU). However, sedating medications are commonly associated with adverse drug events. In fact, in one hospital study, morphine and midazolam were among the top 10 drugs associated with preventable adverse drug events. Other studies have confirmed that sedatives are among the highest-risk medications for adverse drug events. Extra care is needed when dealing with high-risk medications in critical care settings relative to general care wards. In a prospective cohort study of over 4000 adult admissions over a 6-month period, the rate of preventable or potential adverse events in either a surgical or medical ICU was 19 events per 1000 patient days — almost twice that for non-ICU patient care areas. The severity of the adverse drug events and the length of stay were also greater in the ICU setting. One observational study of almost 6000 courses of medication therapy given to 851 patients found that one-quarter of all medication administration errors in the ICU occurred with sedative or analgesic medications. There has been a great deal of research on the use of sedation in critically ill patients. This paper outlines key issues that pharmacists and other clinicians should consider for the appropriate and safe use of sedation in the ICU. It focuses on the “typical” ICU patient and therefore does not cover the use of sedation or neuromuscular blockers for complex ventilation strategies or as part of complex pain control regimens.