Supratherapeutic drug concentration triggers: A novel data-driven approach to assess their value for medication safety surveillance in intensive care

AI Summary

A data-driven EHR approach evaluates electronic supratherapeutic drug concentration triggers as rapid alternatives to time-consuming manual chart review for medication safety surveillance.
Among 6006 ICU admissions, exposure to antibiotic and immunosuppressive eSDCTs linked to higher ICU mortality, higher hospital mortality, and longer ICU length of stay.
Adjusted mixed-effects models confirmed associations for antibiotics and immunosuppressives, supporting their use as surveillance triggers at ICU level.

Br J Clin Pharmacol. 2026 May 21. doi: 10.1002/bcp.70610. Online ahead of print.

ABSTRACT

AIMS: Electronic triggers (e-triggers) are used as screening signals to detect potential adverse drug events (ADEs) and offer an effective system level approach for medication safety surveillance. Their clinical utility is typically evaluated through time-consuming manual chart review by experts, limiting implementation. Estimating associations between e-triggers and relevant ICU patient outcomes may provide a rapid, data-driven alternative. In this study, electronic supratherapeutic drug concentration triggers (eSDCT) were used as a use case.

METHODS: Pseudonymized Electronic Health Record (EHR) data from adults admitted to 14 Dutch ICUs (2010-2020) were analysed. Patients with ≥1 therapeutic drug monitoring measurements were included. eSDCTs were selected based on literature, data availability and expert input. Associations with ICU Length of Stay (LOS), ICU mortality and hospital mortality were assessed using adjusted linear and logistic mixed-effects models.

RESULTS: Among 6006 ICU admissions, 49.5% (n = 2973) had ≥1 of the five selected group-level eSDCTs. Exposed admissions showed higher hospital mortality (38.2% vs. 27.9%), ICU mortality (30.6% vs. 20.3%) and longer ICU LOS (median 13.8 [IQR 5.6-28.1] vs. 7.5 [3.2-15.7] days) compared with unexposed admissions. After adjustment, antibiotic and immunosuppressive eSDCTs remained associated with increased ICU mortality (OR 1.47 [1.26-1.70] and 2.86 [1.56-5.24]), hospital mortality (OR 1.46 [1.27-1.68] and 1.81 [1.07-3.10]) and prolonged ICU LOS (expB 1.82 [1.71-1.94] and 2.99 [2.46-3.62]).

CONCLUSION: Our data-driven approach shows that antibiotic and immunosuppressive eSDCTs are associated with worse ICU patient outcomes, supporting their implementation for ICU-level medication safety surveillance.

PMID:42165122 | DOI:10.1002/bcp.70610

Document this CPD