Pharmacoeconomics and Safe Medication Use
Developed in 2017 with literature searches up to the end of 2015, focused on 34 PICO (population/
problem/patient, intervention/indicator, control/comparator/comparison, and outcomes) questions,
including data on adult and pediatric ICU patients
guide practice is still needed in many areas
Three key components: environment and patient, medication use process, and patient safety surveillance
systems
Recommendations based on GRADE system (quality of evidence: A = high to D = very low; strength of
recommendation: 0 = no recommendation, 1 = strong, 2 = weak)
ICU patients have different risk factors for ADEs, and the severity of medication errors is higher than
with general care (non-ICU) patients (both grade C).
No recommendation was provided regarding disclosure of medication errors/ADEs to patients and/or
family members, because of lack of data, but this is recommended by the National Quality Forum.
Four stages of process (prescribing, dispensing, administration, monitoring)
Guidelines suggest implementing computerized provider order entry to decrease medication
errors and preventable ADEs (2B). Some data support medication error reduction, but evidence is
conflicting, with a decrease in omission errors but an increase in duplicate order errors.
Guidelines suggest using CDS systems to decrease the number of medication errors and ADEs (2C).
CDS systems are tools designed to enhance clinician decision-making (e.g., allergy, drug-drug
interaction, dosing recommendations).
ii.
Trigger-initiated CDS alerts cause a concern for alert fatigue that requires a balance between
sensitivity and specificity because of lack of patient-specific considerations (e.g., ICU level of
care).
Guidelines suggest using protocols/bundles to reduce medication errors/ADEs (2B).
| d. | No recommendation is provided regarding the use of medication reconciliation to decrease |
|---|
medication errors and ADEs in ICU patients or for transitions of care.
Dispensing
Guidelines recommend compliance with safe medication concentration practices (e.g., premade
mixes, standardized medication concentrations within institution) to reduce the number of
medication errors and potential ADEs (1B).
Guidelines suggest use of automated packaging and dispensing of medications to reduce medication
errors/ADEs versus non-automated methods (both 2C).
Guidelines suggest use of medication labeling practices (e.g., tall man lettering) for sound-alike
look-alike drugs to reduce medication errors (2B).