St. Joseph Hospital has found that reducing adverse drug events (ADEs) in the ICU requires the efforts of a multidisciplinary team. Working collaboratively, pharmacists, physicians, nurses, and respiratory therapists in the ICU at the 446-bed hospital in Lexington, Kentucky, USA, a member of Catholic Health Initiatives and IHI’s IMPACT network, have reduced the number of adverse events per ICU day from 8.4 to consistently below 3.0.

The key to success is separating avoidable ADEs from those that are unavoidable, explains Heath Jennings, PharmD, BCPS, a clinical pharmacy specialist. “You don’t want to think that low ADE numbers mean you have eliminated adverse reactions,” says Jennings. “That’s impossible. The goal is to implement measures to prevent anticipated and avoidable events while reporting new and avoidable ones accurately. Tracking is the key to prevention.”

The team started with a baseline ADE rate derived from chart reviews, and then implemented processes to catch adverse events, track them, identify trends, and prevent them, Jennings explains. “One method of avoiding adverse events is through the use of a daily goal sheet,” explains Alan Howard, RN, MSN, a clinical nurse specialist. “The sheet helps the primary care nurse to recognize a potential problem at the bedside and act before an event might occur.” Also a report was created to identify medications with a high risk of ADEs and those commonly used as ADE reversal agents.

Simultaneously, pharmacists began attending patient care rounds with physicians in the ICU, says Yuri Villaran, MD, FCCP, a pulmonologist and critical care specialist. “Multidisciplinary patient care rounds increase the likelihood that potential ADEs are identified before they occur and appropriate changes are made to the patient’s medication regimen to prevent the event,” Villaran says. Jennings agrees, saying, “Without the multidisciplinary approach and the support of our physicians this process would not have been successful.”