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Introduction: There is an increased risk of potential drug-drug interactions (pDDIs) in critically ill patients based on the number of drugs received. The occurrence of pDDIs and clinical significance is not well described.Objective: The aim was to provide insight into important clinical issues and offer guidance on drug-drug interaction (DDI) surveillance through the performance of a systematic review.Methods: Five targeted objectives were developed, a priori, which guided study selection and data abstraction. Two independent reviewers extracted the definition, frequency, type, and clinical significance of pDDIs. A meta-analysis was performed to evaluate the proportion of patients exposed to a pDDI. Three data sources (PubMed, Embase, and Scopus) were utilized for the search to include studies that evaluated pDDIs in adult critically ill patients. Included studies in the systematic review and meta-analysis were required to be full text.Results: A total of 39 studies met inclusion criteria. Definitions of pDDIs were diverse. Frequency of pDDIs varied by study, but was most commonly between one and five pDDIs per patient. Fifty-eight percent of patients were exposed to at least one pDDI during their intensive care unit admission. Types of pDDIs identified were numerous, with aspirin being the most common drug involved. As expected, not all pDDIs were clinically significant. Clinical significance was determined by varied definitions and sources.Conclusions: Improving the understanding of clinically significant pDDIs and alerts that clinicians encounter may guide better development of surveillance through clinical decision support and decrease alert fatigue. [ABSTRACT FROM AUTHOR]

Nephrotoxin exposure accounts for up to one-fourth of acute kidney injury episodes in hospitalized patients, and the associated consequences are as severe as acute kidney injury due to other etiologies. As the use of nephrotoxic agents represents one of the few modifiable risk factors for acute kidney injury, clinicians must be able to identify patients at high risk for drug-induced kidney injury rapidly. Recently, significant advancements have been made in the field of biomarker utilization for the prediction and detection of acute kidney injury. Such biomarkers may have a role both for detection of drug-induced kidney disease and implementation of preventative and therapeutic strategies designed to mitigate injury. In this article, basic principles of renal biomarker use in practice are summarized, and the existing evidence for six markers specifically used to detect drug-induced kidney injury are outlined, including liver-type fatty acid binding protein, neutrophil gelatinase-associated lipocalin, tissue inhibitor of metalloproteinase-2 times insulin-like growth factor-binding protein 7 ([TIMP-2]·[IGFBP7]), kidney injury molecule-1 and N-acetyl-β-D-glucosaminidase. The results of the literature search for these six kidney damage biomarkers identified 29 unique articles with none detected for liver-type fatty acid binding protein and [TIMP-2]·[IGFBP7]. For three biomarkers, kidney injury molecule-1, neutrophil gelatinase-associated lipocalin and N-acetyl-β-D-glucosaminidase, the majority of the studies suggest utility in clinical practice. While many questions need to be answered to clearly articulate the use of biomarkers to predict drug-induced kidney disease, current data are promising. [ABSTRACT FROM AUTHOR]

Background: Mortality and morbidity are increased in patients experiencing drug-drug interactions. Unfortunately, there is a paucity of literature describing clinically significant drug-drug interactions occurring in the intensive care unit (ICU). Knowing the clinically significant drug-drug interactions allows the opportunity for prevention through knowledge and computer-assisted programmes.Objective: To identify significant potential drug-drug interactions occurring in the cardiovascular ICU (CCU) and the cardiothoracic ICU (CTICU).Study Design: Prospective, observational study conducted over a total of 8 weeks in February and March 2009.Setting: CCU and CTICU in a major academic medical centre (Presbyterian Hospital, University of Pittsburgh Medical Centre).Patients: All adult patients (>or=18 years of age) admitted during 1 month in each ICU.Intervention: Micromedex and Lexi-Interact interaction databases were used to screen each patient's medication profile daily for the presence of potentially interacting drug pairs that would be considered a potential drug-drug interaction. A severity assessment using these databases was completed after a potential drug-drug interaction was identified.Primary Outcome Measure: The frequency of significant drug-drug interactions, including those that were considered major or contraindicated, according to two commercially available interaction databases.Results: Evaluations of 400 patient medication profiles were conducted, resulting in 225 profiles possessing one or more potential drug-drug interactions. A total of 1150 potential interactions were identified, resulting in 287.5 potential interactions per 100 patient-days. Of the 1150 potential drug-drug interactions, 458 were unique interacting drug pairs; 5-9% of the potential interactions were considered major or contraindicated. Many of the significant and frequent potential interactions involved blood coagulation modifiers, potential interactions that could result in QTc prolongation, and cytochrome P450 inhibition. Micromedex and Lexi-Interact agreed on the severity ratings in 20.5% of the potential interactions.Conclusions: Significant potential drug-drug interactions occur in the CCU and CTICU, highlighting the need for active surveillance to potentially prevent patient harm. Clinicians should also consider using two references for identifying interactions, due to the lack of congruence between sources. [ABSTRACT FROM AUTHOR]

To compare medication administration error rates before and after the provision of educational sessions using either traditional didactic lecture or simulation-based training. A single-center, parallel, controlled, prospective study conducted in adult coronary critical care (CCU) and medical intensive care units (MICU). Twenty-four nurses were observed administering medications. Documentation included drug name, dose, route, time and technique during observation and active medication orders in the patient’s chart. A direct observation method was completed at baseline and repeated twice after the interventions. Data obtained during observation were analyzed for medication administration error rates. Interventions were two types of educational sessions with content developed from baseline medication administration error data: simulation-based training for CCU nurses and a didactic lecture for MICU nurses. Quizzes completed before and after the interventions were used to assess knowledge. A total of 880 doses (402 CCU, 478 MICU) were observed. After the simulation-based educational intervention in the CCU, medication administration error rates decreased from 30.8 to 4.0% ( p < 0.001) in the initial post-intervention observation and were sustained in the final post-intervention observation (30.8 to 6.2%; p < 0.001). The error rate in the MICU after the didactic lecture intervention was not significantly different from the baseline and increased in the final post-intervention observation from 20.8 to 36.7% ( p = 0.002). Mean quiz scores were significantly improved after education sessions in both ICUs. Simulation-based learning provides a significant advantage to patient care through the reduction of medication administration errors compared to lecture style education. [ABSTRACT FROM AUTHOR]