Research Scholar Department of Pharmacy Practice, JSS College of Pharmacy, Mysuru Mysuru, India
Background: The routine use of antibiotics in intensive care units (ICUs) is crucial for controlling serious infections and preserving life. However, these drugs if used inappropriately can potentially result in a number of medication related problems.
Objectives: To assess the medication related problems associated to antibiotic use in the critical care
Methods: A prospective interventional study was conducted over a period of six months to assess medication-related problems (MRPs) associated to the antibiotic use in ICUs. A combination of chart review and direct observation was used to collect data on demographic information, medical history, medication information, and medication administration. The implementation of a medication safety intervention program, including regular rounds with a pharmacist, education, and technology, was conducted to improve the accuracy of medication administration. Hepler and Strand's classification was used to categorize the DRPs. NCCMERP classification was used to classify medication errors. The data were assessed categorically and the predictors associated with DRPs were determined using odds ratio.
Results: A total of 241 patients were enrolled in the study, [157 (65.14%)], were males and [84 (34.85%)] were females. Majority [56 (23.24%)] of the study participants belonged to the age group of 61-70 years. Majority of the patients [101 (44.69%)] received moderate polypharmacy i.e. 6-10 drugs during their course of hospital stay. A total of 128 drug-related problems were identified associated to antibiotics, the majority of DRPs [38 (29.69%)] were renal dosage adjustment, Drug-Drug Interactions [28 (21.87%)], followed by overdose [24(18.75%)], sub-therapeutic dose [18 (14.06%) and Adverse drug reactions [12 (12.5%)], and others contributed to [12 (9.37%)]. Of the 128 reported DRPs, [114 (89.06%)] were accepted and therapy changed. A total of 156 medication errors were reported, of which [64 (41.02%)] errors were prescribing errors, followed by administration errors [52 (33.33%)] and [36 (23.07%)] were documentation errors. Cephalosporins followed by beta lactams, Carbapenems and tetracyclines were most common antibiotics used in error. According to NCC MERP classification, [64 (41.02%)] errors belonged to Category B, followed by Category C [48 (30.77%)]. Stress and workload were identified as the most common contributing factor to MEs. Polypharmacy and comorbidity were identified as predictors for DRPs.
Conclusions: Although antibiotics may play a critical role when used appropriately, our findings highlight the significance of prudent antibiotic prescribing to minimize the harm that can be caused by antibiotics resulting in Medication Related Problems.
