Valentin et al reported risk factors affecting errors in the administration of parenteral medications in the intensive care unit (ICU). The authors are from multiple ICUs from around the world.


Endpoint: at least 1 error in the administration of a parenteral medication


Types of errors:

(1) missed dose

(2) administration at the wrong time

(3) wrong dose

(4) wrong drug

(5) wrong route


75% of errors were errors of omission.


Most common drugs affected:

(1) antimicrobial agents

(2) sedatives

(3) analgesics


Risk factors for an error:

(1) increased number of organ failures (sicker patient)

(2) receipt of any intravenous medication

(3) increased numbers of parenteral medications

(4) multiple vasoactive medications

(5) larger ICU

(6) greater number of patients per nurse

(7) higher ICU occupancy rate

(8) higher number of interventions typical for the ICU

(9) infusion of drugs previously prepared by the pharmacist

(10) specific intervention performed outside of ICU (suggesting transport to the OR or radiology)


Factors that reduce the risk of an error (absence of these increase risk):

(1) presence of basic patient monitoring

(2) presence of a critical incident reporting system

(3) routine use of checks at nursing shift changes

(4) electronic prescribing system in use

(5) increased ratio of patient turnover to the size of the ICU (relative turnover, associated with shorter ICU stays, which suggests less severe illness)


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