Abstract:
OBJECTIVES:To compare the frequency and preventability of adverse drug events and potential adverse drug events in intensive care units (ICUs) and non-ICUs. To evaluate systems factors involving the individual caregivers, care unit teams, and patients involved in each adverse drug event by comparing ICUs with non-ICUs and medical ICUs with surgical ICUs. DESIGN:Prospective cohort study. Participants included all 4,031 adult admissions to a stratified, random sample of 11 medical and surgical units in two tertiary care hospitals over a 6-month period. Units included two medical and three surgical ICUs and four medical and two surgical general care units. SETTING:Two tertiary care hospitals: Eleven medical and surgical units, including two medical and three surgical ICUs. PATIENTS:Adult admissions (n = 4,031). INTERVENTIONS:None. MEASUREMENTS AND MAIN RESULTS:Rate of preventable adverse drug events and potential adverse drug events, length of stay, charges, costs, and measures of the unit's environment. Incidents were detected by stimulated self-report by nurses and pharmacists and by daily review of all charts by nurse investigators. Incidents were subsequently classified by two independent reviewers as to whether they represented adverse drug events or potential adverse drug events and as to severity and preventability. Those individuals involved in the preventable adverse drug event and potential adverse drug event underwent detailed interviews by peer case-investigators. The rate of preventable adverse drug events and potential adverse drug events in ICUs was 19 events per 1000 patient days, nearly twice that rate of non-ICUs (p <.01). The medical ICU rate (25 events per 1000 patient days) was significantly (p <.05) higher than the surgical ICU rate (14 events per 1000 patient days). When adjusted for the number of drugs used in the previous 24 hrs or ordered since admission, there were no differences in rates between ICUs and non-ICUs. ICU acuity, length of stay, and severity of the adverse drug event were greater in ICUs than non-ICUs, but there were no differences between medical ICU and surgical ICU patients. Structured interviews indicated almost no differences between ICUs and non-ICUs for many characteristics of the patient, patient care team, systems, and individual caregivers. CONCLUSIONS:The rate of preventable and potential adverse drug events was twice as high in ICUs compared with non-ICUs. However, when adjusted for the number of drugs ordered, there was no greater likelihood for preventable adverse drug events and potential adverse drug events to occur in ICUs than in non-ICUs. Preventable adverse drug events and potential adverse drug events occurred in units that functioned normally and involved caregivers who were working under reasonably normal circumstances, not at the extremes of workload, stress, or a difficult environment.
journal_name
Crit Care Medjournal_title
Critical care medicineauthors
Cullen DJ,Sweitzer BJ,Bates DW,Burdick E,Edmondson A,Leape LLdoi
10.1097/00003246-199708000-00014subject
Has Abstractpub_date
1997-08-01 00:00:00pages
1289-97issue
8eissn
0090-3493issn
1530-0293journal_volume
25pub_type
杂志文章abstract:BACKGROUND:Noninvasive positive-pressure ventilation (NPPV) has been shown to be effective in select patients enrolled in clinical trials. However, few data are available on the use of NPPV as routine standard medical care for patients with respiratory failure outside of controlled trials. MEASUREMENTS AND MAIN RESULT...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/01.CCM.0000300084.67277.90
更新日期:2008-02-01 00:00:00
abstract::We evaluated 95 extubated neonates to determine if certain risk factors could predict the development of laryngeal injury. Risk factors were recorded prospectively during the intubation period and correlated with laryngeal injury determined by laryngoscopy after extubation. Duration of intubation greater than or equal...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-198306000-00007
更新日期:1983-06-01 00:00:00
abstract:OBJECTIVE:To assess the intrarater and interrater reliability of electrocardiogram (ECG) interpretation in critically ill patients and to assess the effect of knowledge of cardiac troponin values on these reliability estimates. DESIGN:Prospective cohort study. SETTING:Fifteen-bed medical-surgical intensive care unit....
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/01.CCM.0000214679.23957.90
更新日期:2006-05-01 00:00:00
abstract:OBJECTIVE:Information booklets have not been assessed by the families of intensive care unit (ICU) patients. This study explored the information that the relatives of adult ICU patients wanted to find in the information booklets. DESIGN:Multicenter survey. SETTING:Twenty-three French ICUs. SUBJECTS:One close relativ...
journal_title:Critical care medicine
pub_type: 杂志文章,多中心研究
doi:10.1097/CCM.0b013e3181a03063
更新日期:2009-07-01 00:00:00
abstract::A polarographic conjunctival oxygen sensor was used to measure oxygen tension in a tissue bed supplied by the internal carotid artery. The shared vascular source of the conjunctiva and brain suggests that conjunctival PO2 monitoring may provide an index of cerebral perfusion. We studied the effects of hyperventilation...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-198601000-00003
更新日期:1986-01-01 00:00:00
abstract::Laboratory evaluation and use of the Engström metabolic computer (EMC) in a clinical setting are described. The accuracy of the EMC was tested using an inert gas dilution technique. Mean errors in oxygen consumption (VO2) and CO2 production compared with predicted values were less than 2% of predicted, and generally l...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199008000-00016
更新日期:1990-08-01 00:00:00
abstract::The disciplines of critical care and palliative care may initially seem to be polar opposites, yet they share fundamental features. Both focus on the sickest patients in the healthcare system. Each discipline's primary goal-extending life for critical care and comfort and quality of life for palliative care-represents...
journal_title:Critical care medicine
pub_type: 杂志文章,评审
doi:10.1097/01.CCM.0000237347.94229.23
更新日期:2006-11-01 00:00:00
abstract:OBJECTIVE:Pressure inflating the lung during mechanical ventilation is the difference between pressure applied at the airway opening (Pao) and pleural pressure (Ppl). Depending on the chest wall's contribution to respiratory mechanics, a given positive end-expiratory and/or end-inspiratory plateau pressure may be appro...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/01.CCM.0000215515.49001.A2
更新日期:2006-05-01 00:00:00
abstract:OBJECTIVE:Delirium is common in mechanically ventilated patients in the ICU and associated with short- and long-term morbidity and mortality. The use of systemic corticosteroids is also common in the ICU. Outside the ICU setting, corticosteroids are a recognized risk factor for delirium, but their relationship with del...
journal_title:Critical care medicine
pub_type: 临床试验,杂志文章,多中心研究
doi:10.1097/CCM.0000000000000247
更新日期:2014-06-01 00:00:00
abstract::Vecuronium's short half-life and minimal cardiopulmonary side-effects make it a suitable drug for continuous infusion. Vecuronium is used frequently in critically ill patients to increase their total compliance and to minimize the adverse effects of mechanical ventilation. This crossover, prospective study evaluates t...
journal_title:Critical care medicine
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1097/00003246-198910000-00004
更新日期:1989-10-01 00:00:00
abstract:OBJECTIVE:To describe a postpartum patient who presented with fulminant hepatic failure and hepatic coma as a result of unrecognized peripartum cardiomyopathy. DESIGN:Case report. SETTING:Medical intensive care unit of a tertiary care academic medical center. PATIENT:A 35-yr-old woman 5 wks postpartum from an uneven...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/01.ccm.0000158517.25962.8e
更新日期:2005-04-01 00:00:00
abstract:OBJECTIVE:The adrenal gland is the endocrine organ most commonly involved in patients infected with human immunodeficiency virus (HIV). It is important to recognize patients with adrenal insufficiency, because this disorder may be fatal if untreated. The incidence of adrenal insufficiency in critically ill HIV-infected...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-200206000-00018
更新日期:2002-06-01 00:00:00
abstract:OBJECTIVE:End-of-life practices vary worldwide. The objective was to demonstrate that there is no clear-cut distinction between treatments administered to relieve pain and suffering and those intended to shorten the dying process. DESIGN:Secondary analysis of a prospective, observational study. SETTING:Thirty-seven i...
journal_title:Critical care medicine
pub_type: 杂志文章,多中心研究
doi:10.1097/01.CCM.0000295304.99946.58
更新日期:2008-01-01 00:00:00
abstract:OBJECTIVES:Racial/ethnic differences in palliative care resource use after stroke have been recognized, but it is unclear whether patient or hospital characteristics drive this disparity. We sought to determine whether palliative care use after intracerebral hemorrhage and ischemic stroke differs between hospitals serv...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000002762
更新日期:2017-12-01 00:00:00
abstract:OBJECTIVE:Very elderly persons admitted to ICUs are at high risk of death. To document life-sustaining interventions (mechanical ventilation, vasopressors, renal replacement therapy) provided in the ICU and outcomes of care. DESIGN:Multicenter, prospective cohort study. SETTING:ICUs of 24 Canadian hospitals. PARTICI...
journal_title:Critical care medicine
pub_type: 杂志文章,多中心研究
doi:10.1097/CCM.0000000000001024
更新日期:2015-07-01 00:00:00
abstract:OBJECTIVE:To determine if exogenous interleukin (IL)-10 will decrease the morbidity or mortality of sepsis induced by cecal ligation and puncture. DESIGN:Prospective, randomized, controlled study. SETTING:University research laboratory. SUBJECTS:Adult, female, Balb¿c mice. INTERVENTIONS:Balb¿c mice were subjected t...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199805000-00025
更新日期:1998-05-01 00:00:00
abstract:OBJECTIVES:To determine whether delirium during ICU stay is associated with long-term mental health problems defined as symptoms of anxiety, depression, and posttraumatic stress disorder. DESIGN:Prospective cohort study. SETTING:Survey study, 1 year after discharge from a medical-surgical ICU in the Netherlands. PAT...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000001861
更新日期:2016-10-01 00:00:00
abstract:OBJECTIVES:The aim of this study was to evaluate the efficacy of perioperative intra-aortic balloon pump use in high-risk cardiac surgery patients. DESIGN:A single-center randomized controlled trial and a meta-analysis of randomized controlled trials. SETTING:Heart Institute of São Paulo University. PATIENTS:High-ri...
journal_title:Critical care medicine
pub_type: 杂志文章,随机对照试验
doi:10.1097/CCM.0000000000003185
更新日期:2018-08-01 00:00:00
abstract:OBJECTIVES:Cardiac arrest etiology may be an important source of between-patient heterogeneity, but the impact of etiology on organ injury is unknown. We tested the hypothesis that asphyxial cardiac arrest results in greater neurologic injury than cardiac etiology cardiac arrest (ventricular fibrillation cardiac arrest...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000003070
更新日期:2018-06-01 00:00:00
abstract:OBJECTIVE:To discuss the potential therapeutic value of intraluminal oxygenation of the gut in critical illness. DATA SOURCES:Relevant articles published in the English language literature. STUDY SELECTION:No special study has been carried out for the present presentation. DATA EXTRACTION:Information from the litera...
journal_title:Critical care medicine
pub_type: 杂志文章,评审
doi:10.1097/00003246-199302001-00012
更新日期:1993-02-01 00:00:00
abstract:BACKGROUND:Pneumonia accounts for almost half of intensive care unit (ICU) infections and nearly 60% of deaths from nosocomial infections. It increases hospital stay by 7-9 days, crude mortality by 70% and attributable mortality by 30%. OBJECTIVE:Our purpose was to assess the impact of standard operating procedures ad...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0b013e3181934f1b
更新日期:2009-01-01 00:00:00
abstract:OBJECTIVE:The aim of this study was to determine whether changing heat and moisture exchangers (HMEs) every 96 hrs rather than 24 hrs would affect their efficacy to preserve the heat and moisture of inspiratory gases. The impact of a prolonged use of the HME on its microbial colonization was also assessed. DESIGN:Pros...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-200003000-00019
更新日期:2000-03-01 00:00:00
abstract:OBJECTIVE:Trauma induces a complex immune response that requires a systems biology research approach. Here, we used a novel technology, mass cytometry by time-of-flight, to comprehensively characterize the multicellular response to trauma. DESIGN:Peripheral blood mononuclear cells samples were stained with a 38-marker...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000002577
更新日期:2017-09-01 00:00:00
abstract:OBJECTIVE:To establish the effect of an audible airleak (around an endotracheal tube) on oxygen consumption (VO2) measurements in pediatric ICU patients. DESIGN:Prospective trial comparing VO2 measurements before and after deflation of the endotracheal tube cuff. SETTING:Pediatric ICU in a large pediatric tertiary ca...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199206000-00012
更新日期:1992-06-01 00:00:00
abstract:OBJECTIVE:To compare the effects of cardiac surgery with and without extracorporeal circulation on the mechanics of the respiratory system, lung, and chest wall. We also determined the time course of those effects. DESIGN:Prospective, controlled study. SETTING:An eight-bed, cardiac-surgical intensive care unit at a u...
journal_title:Critical care medicine
pub_type: 临床试验,杂志文章
doi:10.1097/00003246-200211000-00005
更新日期:2002-11-01 00:00:00
abstract:OBJECTIVES:Peripherally inserted central catheters are increasingly used in ICU as an alternative to centrally inserted central catheters for IV infusion. However, their reliability for hemodynamic measurements with transpulmonary thermodilution is currently unknown. We investigated the agreement between transpulmonary...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000003917
更新日期:2019-10-01 00:00:00
abstract:OBJECTIVE:To determine the effectiveness of increasing the preoxygenation period with 100% oxygen in the critically ill patient from 4 to 8 mins in preparation for emergency tracheal intubation. DESIGN:Nonrandomized, controlled trial. SETTING:Large, level one trauma center, tertiary care intensive care unit. PATIENT...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0b013e318192845e
更新日期:2009-01-01 00:00:00
abstract:OBJECTIVE:The Cardiac Arrhythmia Suppression Trial II showed that moricizine acutely increases the occurrence of sudden cardiac death. Thus the objective of this investigation was to evaluate the antifibrillatory properties of moricizine (a new antiarrhythmic agent) alone and in combination with lidocaine (an establish...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199310000-00029
更新日期:1993-10-01 00:00:00
abstract:OBJECTIVE:To test the hypothesis that trauma-hemorrhagic shock (T/HS)-induced changes in red blood cells (RBC) contribute to the reduction of blood flow in distant organs. DESIGN:Laboratory study. SETTING:Academic medical center laboratory. SUBJECTS:Specific pathogen-free male Sprague-Dawley rats weighing between 25...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0b013e3181962d39
更新日期:2009-03-01 00:00:00
abstract:BACKGROUND:Acute lung injury (ALI) and its more severe form, acute respiratory distress syndrome (ARDS), are devastating disorders of overwhelming pulmonary inflammation and hypoxemia, resulting in high morbidity and mortality. AIM:To provide the clinician with a summary of the literature on the epidemiology, diagnosi...
journal_title:Critical care medicine
pub_type: 杂志文章,评审
doi:10.1097/CCM.0b013e3181aee5dd
更新日期:2009-08-01 00:00:00