Pharmacoeconomics and Safe Medication Use

Administration

Guidelines suggest use of bar code medication administration (BCMA) to reduce medication errors

and/or ADEs in the ICU (2C).

Conflicting evidence on benefit, though data largely suggest reduction in medication errors and

potential ADEs

ii.

One limitation of BCMA is that workarounds will reduce effectiveness.

Guidelines suggest smart intravenous infusion pumps be used to reduce the rate of medication

errors and ADEs (2C).

Evidence is conflicting on the use of the guardrails and the types of errors evaluated.

ii.

Concern for auditory alarm fatigue exists with smart pumps, especially in the context of other

auditory alarms in the ICU.

Guidelines recommend use of direct observation as an active medication surveillance system to identify

the medication errors (1A).

number of ADEs identified, though this is a resource-intensive process (2C).

Guidelines suggest targeted chart review to increase ability to detect ADEs compared with voluntary

reporting (2B). Strategies include evaluation of only a specific section of the patient’s medical record

(e.g., ICU discharge note, laboratory abnormalities in the setting of certain drugs) or trigger medications.

Guidelines suggest patient and family reporting at or after ICU discharge to improve medication error

and ADE detection (2C). This includes formalization of a process for interviewing patients or family

members about possible medication errors or ADEs that occurred while the patient was in the ICU.

When the effects of one drug can be changed by the presence of another substance (e.g., medication,

dietary), which may be intentional, clinically insignificant, or harmful and potentially life threatening

discontinuation of medication).

ADE, or an ADR, depending on clinical context.

likelihood of prolonged infusions.

Hansten and Horn’s Drug Interaction Analysis and Management, Stockley’s Drug Interactions, and PDR

Drug Interactions. Many EHRs include Medi-Span and First Databank.

Most compilation databases have drug interaction software in which the pharmacist can provide a list

of drugs and the database will provide the type of interaction and severity. Of note, agreement between

databases for severity of interactions is estimated to be less than 50%.

Clinical judgment should always be applied when assessing drug interactions.