Identifying risk factors for adverse drug events in intensive care unit provides actionable opportunities to customize medication management*.
Identifying risk factors for adverse drug events in intensive care unit provides actionable opportunities to customize medication management*.
复制标题
识别重症监护病房药物不良事件的风险因素为定制药物管理*提供了可行的机会。
DOI：
10.1097/ccm.0b013e31823b96eb
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发表时间：
2012
影响因子：
8.8
通讯作者：
Nuckols,TerylK
中科院分区：
文献类型：
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作者：
Nuckols,TerylK
Kane-Gill博士及其同事为这期《重症监护医学》杂志做出了贡献，该杂志确定了重症监护病房（ICU）中哪些患者有发生药物不良事件（ADE）的风险，以及哪些类型的药物最有问题（1）。这一进步很重要，因为尽管存在技术修复，如计算机化的医嘱输入，智能静脉注射泵和条形码系统，但药物安全问题尚未得到解决。实现安全技术的全面实施一直具有挑战性（2，3），但ADE继续发生的主要原因是它们有无数的原因。例如，只有少数可归因于处方或管理错误，许多涉及提供者在出现药物不良反应后忽视及时干预（2-4）。因此，患者受益于持续的定制药物管理，例如，通过药剂师参与床边查房（5）。在这篇文章中，Kane-Gill博士及其同事提供了可操作的信息，通过使医生和药剂师更好地了解ADE的患者相关和药物相关风险因素，可以加强这种定制化护理。ADE的患者相关风险因素（来自单变量分析）包括急性肾损伤、血小板减少症、急诊/急诊入院以及住院和ICU住院时间。与药物相关的风险因素包括具有狭窄的治疗指数、与蛋白质结合、具有酶诱导性、具有酶抑制性、被归类为高风险、通过静脉内或口服途径给药以及来自五种特定类别的药物。最后，使用大量药物治疗也是一个风险因素（1）。总的来说，这些发现具有高度的表面效度，即它们与人们所期望的一致。在大多数情况下，研究结果也具有结构效度，这意味着它们与理论戒律一致。同样的作者在这本《重症监护医学》的前一期中详细解释了这些戒律（6）。
Dr. Kane-Gill and colleagues provide a contribution to this issue of Critical Care Medicine that identifies which patients are at risk for adverse drug events (ADEs) in intensive care units (ICUs) and which types of drugs are most problematical (1). This advance is important because despite the existence of technological fixes, such as computerized physician order entry, smart intravenous pumps, and barcode systems, medication safety problems have not been solved just yet. Attaining full implementation of safety technologies has been challenging (2, 3), but the main reason that ADEs continue to occur is that they have myriad causes. For example, only a minority are attributable to prescribing or administration errors, and many involve providers neglecting to intervene in a timely manner after adverse medication effects appear (2–4). Therefore, patients benefit from customized management of their medications on an ongoing basis, for instance, through pharmacist participation in bedside rounds (5). In the current article, Dr. Kane-Gill and colleagues provide actionable information that can enhance such customized care by enabling physicians and pharmacists to better-understand the patient-related and drug-related risk factors for ADEs.The patient-related risk factors for ADEs (from the univariate analyses) include acute kidney injury, thrombocytopenia, emergent/urgent admission, and both hospital and ICU lengths of stay. The drug-related risk factors include having a narrow therapeutic index, being protein-bound, being enzyme-inducing, being enzyme-inhibiting, being categorized as high-risk, being administered via the intravenous or oral routes, and being from one five specific classes of drugs. Last, treatment with a large number of drugs is also a risk factor (1). In general, these findings have a high degree of face validity, ie, they are consistent with what one would expect. For the most part, the findings also have construct validity, meaning they are consistent with theoretical precepts. The same authors have explicated such precepts in detail in a previous issue of this Critical Care Medicine (6).