Antimicrobial prescription errors and the impact on the patient's hospitalization in the ICU
Keywords:
Patient Safety, Medication Errors, Antimicrobials, Intensive Care Units, Length of HospitalizationAbstract
Introduction: Patients hospitalized in Intensive Care Units (ICU) have a more complex clinic and are more susceptible to polypharmacy with antibiotics, and this factor can compromise the care with safe patient care. Objective: To verify patient safety in the prescription of antibiotics in the ICU and its relationship with the length of stay in a large hospital located in the north of Rio Grande do Sul, Brazil. Methodology: Cross-sectional study in which electronic medical records of patients admitted to the ICU, from February to May 2019, using antibiotics and hospitalization longer than 48 hours, were analyzed. The following variables were considered: age, gender, underlying disease, comorbidities, length of ICU stay, clinical outcome, antibiotic prescribed, and antibiotic prescription errors. For statistical analysis, SPSS 2.5 statistical program was used. Approval CAAE 99487118.5.0000.5343. Findings: 238 patients admitted to the ICU were prescribed antibiotics, with a prevalence of males (54.6%) and 51.3% as the main clinical outcome were discharged. The main underlying diseases were neurological (21%), cardiac (19.7%) and infectious (16.8%). The most prescribed antibiotics, vancomycin 500mg (31.5%), ceftriaxone 1g (31.1%) and meropenem 1g (30.7%). The presence of comorbidities such as acute renal 1.77 (1.11-2.81), hepatic 1.78 (1.05-3.02) and immunodeficiency 1.78 (1.27-2.49) presented a significant prevalence ratio for length of hospital stay. It was observed that regardless of the age of the patients, with each prescription error, the more antibiotics are prescribed, and according to the comorbidities, approximately 7, 3.4 and 2 days of hospitalization are prolonged, respectively. Conclusion: Patient safety is directly impaired with each antibiotic prescription error and the greater the number of these drugs prescribed to ICU patients, the higher the prevalence of length of stay.
