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SANDRA KANE-GILL, PHARM.D., M.SC., is Assistant Professor, Department of Pharmacy and Therapeutics, Center for Pharmacoinformatics and Outcomes Research, School of Pharmacy, University of Pittsburgh (UP), Pittsburgh, PA. RHONDA S. REA, PHARM.D., is Assistant Professor, Department of Pharmacy and Therapeutics, School of Pharmacy, UP, and Critical Care Specialist, Medical Intensive Care Unit, University of Pittsburgh Medical Center (UPMC), Pittsburgh. MARGARET M. VERRICO, B.S., is Assistant Professor, Department of Pharmacy and Therapeutics, School of Pharmacy, UP, and Drug Information Pharmacist, UP Drug Information Center, UPMC. ROBERT J. WEBER, M.S., FASHP, is Associate Professor and Chairman, Department of Pharmacy and Therapeutics, School of Pharmacy, UP, and Chief Pharmacy Officer, UPMC.

Address correspondence to Dr. Kane-Gill at the Center for Pharmacoinformatics and Outcomes Research, University of Pittsburgh, 918 Salk Hall, 3501 Terrace Street, Pittsburgh, PA 15261 (kanesl{at}upmc.edu).

Purpose. The rates of adverse drug events (ADEs) associated with high-cost and high-use drugs in the intensive care unit (ICU) were studied. Methods. This retrospective analysis was conducted from October 1997 through June 2001 in a 647-bed academic medical center with over 120 ICU beds. Adult patients with a documented ADE occurring in the ICU were included in the analysis. ADE information, including suspected medication, causality, preventability, and severity, was extracted from the institutional ADE database. Published definitions of ADEs and published scales for causality and severity assessments were used. High-cost medications were those in the top 50% of cumulative ICU medication costs, and high-use medications accounted for the upper 50% of all medications used in the ICU. Between-group comparisons of ADE rates, preventability, and severity associated with high-cost and high-use medications were conducted. Results. Of the 17 medications that were considered high cost, 9 (53%) were associated with ADEs. Of the 15 medications that met the criteria for high-use drugs, 12 (80%) were associated with ADEs. The rates of ADEs associated with high-cost and high-use drugs did not significantly differ (43% versus 75%, respectively; p = 0.098). ADEs associated with high-cost and high-use medications were categorized as mild (15% versus 10%, respectively), moderate (52% versus 50%, respectively), and severe (33% versus 40%, respectively) (p > 0.05). Conclusion. The frequency, severity, and preventability of ADEs in the ICU were not associated with a drug’s cost or frequency of use. Monitoring priorities of the critical care pharmacist should not be dictated by cost alone but should include frequency of use and the potential for causing an ADE. Index terms: Costs; Drug use; Drugs, adverse reactions; Errors, medication; Hospitals; Pharmacists, hospital