Brian L Erstad

Abstract:

Purpose: The authors conducted a retrospective chart review to determine if metoclopramide was being used properly for ileus and if it caused any adverse effects. Methods: All adult patients admitted to the institution's ICUs between November 10, 2000 and January 31, 2001 were evaluated for enrollment. Data was obtained from medication administration records, patient flow sheets, the computer-based laboratory and report systems, and a database of adverse drug events. Bowel movements were used to assess effectiveness. The primary endpoint was the length of time metoclopramide was continued after the first bowel movement. A secondary endpoint was the occurrence of any adverse effects related to metoclopramide administration. Results: There were a total of 32 patients who received metoclopramide for ileus during the time period studied. The average number of days people received metoclopramide was 11.5 ± 7.3 days. The mean time to first bowel movement was 1.7 ± 1.4 days. Patients had therapy continued after first bowel movement for an average of 10.7 ± 7.1 days. Extrapyramidal symptoms possibly occurred in 3% of the patients. Conclusion: The results suggest that metoclopramide was used for the treatment of ileus in ICU patients for prolonged periods of time. This overuse may place patients at risk for adverse events and may also occur at other institutions.

This study sought to identify the medication class most commonly prescribed for stress ulcer prophylaxis (SUP), assess trends in SUP utilization, and report the use of acid suppressive therapy stratified by bleeding risk.

PMID: 14758159;Abstract:

Objective: To document the incidence of medication errors related to medications administered by continuous infusion. Design: Observational study. Setting: Sixteen-bed surgical intensive care unit. Measurements and Main Results: All continuous infusions in the surgical intensive care unit were evaluated at least once daily for correct flow-sheet charting, concentration, infusion rate, and dose administered, as well as patients' heights and weights (actual, ideal, and "dry"). Collected information was examined to determine the error rate, types of errors occurring, and weight used for dose calculation. Variations inpatient weight measures were compared. Seventy-one patients with 202 total infusions were observed. Errors involving continuously infused medications in our surgical intensive care unit occurred at a rate of 105.9 per 1,000 patient days. For nonweight-based infusions, 94% of doses were delivered correctly. Slightly >10% of the doses administered for weight-based infusions (dose based on dry body weight) were incorrect. Significant differences were found between the weight measurements recorded, but this did not translate into statistically significant differences in the apparent calculated doses delivered. Conclusions: Medications delivered by continuous infusion, particularly those that are weight based, can contribute to medication errors in the intensive care unit. A large proportion (87.6%) of doses for weight-based infusions was calculated based on estimated or unreliable admission weights. There were no severe consequences resulting from the errors observed in this 1 month investigation; however, depending on the pharmacokinetic characteristics of the drug being administered, there is a potential to deliver artificially low or high doses resulting in subtherapeutic or adverse effects.

Abstract:

Objective: The objective of this study was to determine if patients who weigh ≥100 kg are more likely to receive under-dosing of etomidate compared to those who weigh 100 kg for rapid sequence intubation in the emergency department (ED). Methods: This was a retrospective cohort study conducted in an academic ED in the United States. Adult patients who received etomidate for rapid sequence intubation were evaluated and categorized into two groups based on weight: 1) 100 kg or 2) ≥100 kg. The mean dose of etomidate (mg/kg) was compared between the groups using an unpaired Student's t-test. The percentage of patients who received under-dosing (less than 0.2 mg/kg) was compared between groups using the Chi-squared test. Results: A total of 200 patients were included in the final analyses (100 patients in the 100 kg group and 100 patients in the ≥100 kg group). There were no baseline differences in age, sex, paralytic used, or trauma status between the treatment groups. The mean etomidate dose (mg/kg ± standard deviation) was significantly lower in the ≥100 kg group compared to the 100 kg group (0.18 ± 0.03 vs 0.28 ± 0.07, respectively; p0.001). There were significantly more patients in the ≥100 kg group who received under-dosing of etomidate compared to the 100 kg group (68% vs 2%, respectively; p0.001). Conclusions: Patients who weigh ≥100 kg are more likely to receive under-dosing of etomidate compared to those who weigh 100 kg for rapid sequence intubation in the ED. © 2013 Bentham Science Publishers.

We determine the rate and severity of medication errors, as well as factors associated with error occurrence in the emergency department (ED).