Minimising drug errors in critically ill patients

Abstract

Klopotowska and colleagues underscore the value of the hospital pharmacists’ expertise in reducing medication errors and improving patient safety in critical care [1]. Th e authors emphasise that drug inaccuracies are frequent and that the limited physiological reserve of critically ill individuals increases the potential harm of adverse prescribing. Critically ill patients represent a unique population with altered pharmacokinetics, and it is likely that the rate of suboptimal prescribing may be even greater than suggested by the current study [2,3]. Notably, Klopotowska and colleagues identifi ed that most errors were focused on drug monitoring and suboptimal and incorrect dosing; typically involving antibiotics, drugs used less frequently in critical care and drugs with rapid-change profi les such as anti-thrombotics. It would have been informative to subcategorise errors by clinical grade (intensivist, fellow, resident); however, it is noteworthy that errors increased during the period with new residents. Training is a central issue because there are features unique to prescribing in this population and residents require additional support. Residents are integral to the processes that underpin many risk factors for medication error [4]. From the outset of their critical care experience, residents are required to prescribe drugs not previously encountered and to chart drugs with unfamiliar routes, rates and indications. Th e impact of the limited pharmacy intervention package described in this study [1] could be extended by giving new prescribers an induction focusing on what is unique to critically ill patients. Th is induction might be delivered as an online resource, undertaken prior to starting in critical care and reiterated as help boxes in electronic prescribing.