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Safety of intravenous metoprolol use in unmonitored wards: a single-centre observational study
D Kelly1, G Hawdon1, J Reeves1
1Intensive Care, Cabrini Hospital - Malvern, Melbourne, Victoria, Australia.
Background And Aim:
This study aims to examine and quantify the risks associated with the use of intravenous metoprolol on unmonitored wards.
Method:
This study was a retrospective single-centre observational study from 1 January 2009 to 31 December 2013. The study hospital was a 415-bed, private hospital in Melbourne, Victoria. The study population was all patients who received intravenous metoprolol on an unmonitored ward. The primary outcome measure was the rate of serious adverse events (SAE), defined as a complication of intravenous metoprolol resulting in transfer to a critical-care environment, a medical emergency team call or death.
Results:
Six hundred and nine patients received a total of 8260 doses of intravenous metoprolol. Seven cases were identified with a SAE deemed possibly related to beta-blocker use and there was one death. All SAE were hypotension, giving an overall rate of hypotension of 7/609 or 1.1% (95% confidence interval (CI), 0.5 to 2.4%) with a rate per dose delivered of 0.8/1000 doses (95% CI 0.3 to 1.7). The death occurred in a 94-year-old woman with abdominal sepsis. After case file review, consensus opinion deemed this to be unrelated to intravenous metoprolol.
Conclusion:
The use of intravenous metoprolol on unmonitored wards appears to be safe. The complication rate was low, suggesting that this may be a sensible approach to the management of in-hospital populations at risk of beta-blocker withdrawal.
Insights
Intravenous metoprolol use on unmonitored wards showed a low rate of serious adverse events, primarily hypotension. This suggests it is a safe option for managing patients at risk of beta-blocker withdrawal.
Area of Science:
- Cardiology
- Pharmacology
- Patient Safety
Background:
- Intravenous metoprolol is commonly used for various cardiovascular conditions.
- Unmonitored wards present unique challenges for administering potent medications like beta-blockers.
- Assessing the safety of intravenous metoprolol in these settings is crucial for patient care.
Purpose of the Study:
- To quantify the risks of serious adverse events (SAEs) associated with intravenous metoprolol administration on unmonitored hospital wards.
- To evaluate the incidence of hypotension and other complications.
- To determine the safety profile of this practice.
Main Methods:
- Retrospective, single-centre observational study.
- Inclusion of all patients receiving intravenous metoprolol on unmonitored wards between 2009 and 2013.
- Primary outcome: rate of SAEs (transfer to critical care, medical emergency team call, or death).
Main Results:
- 609 patients received 8260 doses of intravenous metoprolol.
- Seven cases of SAEs (1.1%) possibly related to metoprolol, all being hypotension.
- One death occurred but was deemed unrelated to metoprolol after review.
Conclusions:
- Intravenous metoprolol administration on unmonitored wards appears safe.
- The low complication rate supports its use in managing patients at risk of beta-blocker withdrawal.
- This practice may be a viable strategy in specific in-hospital populations.
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