Incidence of medication errors and adverse drug events in the ICU: a systematic review -- Wilmer et al. -- Quality and Safety in Health Care

Qual Saf Health Care doi:10.1136/qshc.2008.030783
Original research
Incidence of medication errors and adverse drug events in the ICU: a systematic review
Amanda Wilmer1,2, Kimberley Louie1,2, Peter Dodek1,2,3, Hubert Wong3, Najib Ayas1,2,4,5
+ Author Affiliations

1Program in Critical Care Medicine and the Department of Medicine, Providence Health Care, Vancouver, British Columbia, Canada
2Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
3Center for Health Evaluation and Outcome Sciences, Vancouver, British Columbia, Canada
4Respiratory Division, Vancouver General Hospital, Vancouver, British Columbia, Canada
5Center for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada

Correspondence to
Dr Najib Ayas, 224 Comox Building, St Pauls Hospital, 1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada; nayas@providencehealth.bc.ca

Accepted 20 April 2009
Published Online First 29 July 2010

Abstract
Background Medication errors (MEs) and adverse drug events (ADEs) are both common and under-reported in the intensive care setting. The definitions of these terms vary substantially in the literature. Many methods have been used to estimate their incidence.

Methods A systematic review was done to assess methods used for tracking unintended drug events in intensive care units (ICUs). Studies published up to 22 June 2007 were identified by searching eight online databases, including Medline. In total, 613 studies were evaluated for inclusion by two reviewers.

Results The authors selected 29 papers to analyse; all studies took place in an ICU, were reproducible and reported ICU-specific rates of events. Rates of MEs varied from 8.1 to 2344 per 1000 patient-days, and ADEs from 5.1 to 87.5 per 1000 patient-days. The definitions of ADE and ME in the studies varied widely.

Conclusions Much variation exists in reported rates and definitions of ADEs and MEs in ICUs. Some of this variation may be due to a lack of standard definitions for ADEs and MEs, and methods for detecting them. Further standardisation is needed before these methods can be used to evaluate process improvements.
Incidence of medication errors and adverse drug events in the ICU: a systematic review -- Wilmer et al. -- Quality and Safety in Health Care