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Medication errors in anaesthesia and critical care.
Wheeler SJ, Wheeler DW.
University Department of Anaesthesia, University of Cambridge, BOX 93, Addenbrooke's Hospital, Cambridge, CB2 2QQ, UK.
There is an increasing recognition that medication errors are causing a substantial global public health problem, as many result in harm to patients and increased costs to health providers. However, study of medication error is hampered by difficulty with definitions, research methods and study populations. Few doctors are as involved in the process of prescribing, selecting, preparing and giving drugs as anaesthetists, whether their practice is based in the operating theatre, critical care or pain management. Anaesthesia is now safe and routine, yet anaesthetists are not immune from making medication errors and the consequences of their mistakes may be more serious than those of doctors in other specialties. Steps are being taken to determine the extent of the problem of medication error in anaesthesia. New technology, theories of human error and lessons learnt from the nuclear, petrochemical and aviation industries are being used to tackle the problem.
Publication Types:
PMID: 15710011 [PubMed - indexed for MEDLINE]
Comment on:
Evidence for expanding physician supply.
Rounds SI, Angus DC.
Publication Types:
PMID: 15767630 [PubMed - indexed for MEDLINE]
Documented and clinically suspected bacterial infection precipitating intensive care unit admission in patients with hematological malignancies: impact on outcome.
Benoit DD, Depuydt PO, Peleman RA, Offner FC, Vandewoude KH, Vogelaers DP, Blot SI, Noens LA, Colardyn FA, Decruyenaere JM.
Department of Intensive Care, Medical Intensive Care Unit, 12K12IB, De Pintelaan 185, 9000, Ghent, Belgium.
OBJECTIVE: To assess the impact of documented and clinically suspected bacterial infection precipitating ICU admission on in-hospital mortality in patients with hematological malignancies.DESIGN AND SETTING: Prospective observational study in a 14-bed medical ICU at a tertiary university hospital.PATIENTS: A total of 172 consecutive patients with hematological malignancies admitted to the ICU for a life-threatening complication over a 4-year period were categorized into three main groups according to their admission diagnosis (documented bacterial infection, clinically suspected bacterial infection, nonbacterial complications) by an independent panel of three physicians blinded to the patient's outcome and C-reactive protein levels.RESULTS: In-hospital and 6-months mortality rates in documented bacterial infection (n=42), clinically suspected bacterial infection (n=40) vs. nonbacterial complications (n=90) were 50.0% and 42.5% vs. 65.6% (p=0.09 and 0.02) and 56.1% and 48.7% vs. 72.1% (p=0.11 and 0.02), respectively. Median baseline C-reactive protein levels in the first two groups were 23 mg/dl and 21.5 mg/dl vs. 10.7 mg/dl (p<0.001 and p=0.001) respectively. After adjustment for the severity of critical and underlying hematological illness and the duration of hospitalization before admission documented (OR 0.20; 95% CI 0.06-0.62, p=0.006) and clinically suspected bacterial infection (OR 0.18; 95% CI 0.06-0.53, p=0.002) were associated with a more favorable outcome than nonbacterial complications.CONCLUSIONS: Severely ill patients with hematological malignancies admitted to the ICU because of documented or clinically suspected bacterial infection have a better outcome than those admitted with nonbacterial complications. These patients should receive advanced life-supporting therapy for an appropriate period of time.
PMID: 15782316 [PubMed - as supplied by publisher]
Comment on:
Streamlining weaning: protocols and weaning units.
Simonds AK.
Publication Types:
PMID: 15741427 [PubMed - indexed for MEDLINE]
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