Limiting harm in the ICU.

Abstract

This year, the US Institute of Medicine has estimated that medical errors kill up to 98,000 Americans each year,1 a problem surpassing automobile fatalities. For patients on the medical ward, drug therapy is the primary intervention they are receiving yet medication errors occur in as many as 4% of inpatients.2 Although greater monitoring intensity and much lower nurse-patient ratios in the ICU may reduce the incidence of medication errors, the shear number if interventions dramatically increases the risk of error.3 Furthermore, the study by the Institute of Medicine only addressed a small part of the problem. The taxonomy of errors includes both "accidents" (skill-based errors) and intentional "mistakes" (knowledge-based and rule-based errors).2 Thus, the Institute of Medicine would not consider the proscribing of human growth hormone for cachexia an error unless the proscribed dose was not administered or it was given to the wrong patient. In the ICU, the risks associated with both kinds of errors are considerable. In this review we will focus on the second kind of errors and examine harms associated with the care of patients with sepsis.