AN EXPLORATORY ANALYSIS OF MEDICATION UTILIZATION IN A MEDICAL INTENSIVE-CARE UNIT

Objectives. To evaluate patterns of medication use in a medical intens ive care unit (ICU) and to explore relationships between drug use, pat ient age, admitting diagnosis, Acute Physiology and Chronic Health Eva luation (APACHE II) scores, length of stay, and survival. Design: Comb ination prospective and retrospective study. Setting. Medical ICU in a large teaching institution. Patients: Patient admissions (n = 191) to a medical ICU during a 4-month study period. Interventions: The follo wing data were collected: age, length of stay, diagnosis, physiologic variables necessary for APACHE II scores, medications administered, an d survival. Measurements and Main Results. The mean length of stay of the study patients was 5.2 +/- 9.8 days. Overall mortality rate was 33 %. The mean age of survivors, 62.7 yrs, was significantly (p < .05) lo wer than that value for nonsurvivors (68.6 yrs). Postcardiopulmonary r esuscitation (CPR) or -stroke patients had a mortality rate that was h igher than the overall mortality rate (p < .05). APACHE II scores of > 19 were associated with a reduced survival rate when compared with the overall mortality rate. The mean daily and mean total number of medic ations administered per patient were 7.5 +/- 3.4 and 12.1 +/- 7.6, res pectively. Antihypertensives/vasodilators and gastrointestinal prophyl axis medications were administered most commonly in 69% and 65% of pat ients, respectively. The median total drug use per patient was signifi cantly greater in nonsurvivors vs. survivors (13 and 10, respectively, p < .02). There was a positive linear relationship between total medi cation use and log length of stay (r2 = .62). Patients admitted post-C PR or with seizures received the highest number of medications (p < .0 5). Conclusions. Patients admitted to the medical ICU receive multiple medications from a variety of pharmacologic classes. Prolonged length of stay, certain admitting diagnoses, and death are associated with i ncreased medication administration. Age, certain admitting diagnoses, and APACHE II scores are significantly related to survival.