BackgroundPatients recovering from an episode in an intensive care unit (ICU) frequently experience medication errors on transition to the hospital ward. Structured handover recommendations often underestimate the challenges and complexity of ICU patient transitions. For adult ICU patients transitioning to a hospital ward, it is currently unclear what interventions reduce the risks of medication errors.The aims were to examine the impact of medication-related interventions on medication and patient outcomes on transition from adult ICU settings and identify barriers and facilitators to implementation.MethodsThe systematic review protocol was preregistered on PROSPERO. Six electronic databases were searched until October 2020 for controlled and uncontrolled study designs that reported medication-related (ie, de-prescribing; medication errors) or patient-related outcomes (ie, mortality; length of stay). Risk of bias (RoB) assessment used V.2.0 and ROBINS-I Cochrane tools. Where feasible, random-effects meta-analysis was used for pooling the OR across studies. The quality of evidence was assessed by Grading of Recommendations, Assessment, Development and Evaluations.ResultsSeventeen studies were eligible, 15 (88%) were uncontrolled before-after studies. The intervention components included education of staff (n=8 studies), medication review (n=7), guidelines (n=6), electronic transfer/handover tool or letter (n=4) and medicines reconciliation (n=4). Overall, pooled analysis of all interventions reduced risk of inappropriate medication continuation at ICU discharge (OR=0.45 (95% CI 0.31 to 0.63), I2=55%, n=9) and hospital discharge (OR=0.39 (95% CI 0.2 to 0.76), I2=75%, n=9). Multicomponent interventions, based on education of staff and guidelines, demonstrated no significant difference in inappropriate medication continuation at the ICU discharge point (OR 0.5 (95% CI 0.22 to 1.11), I2=62%, n=4), but were very effective in increasing de-prescribing outcomes on hospital discharge (OR 0.26 (95% CI 0.13 to 0.55), I2=67%, n=6)). Facilitators to intervention delivery included ICU clinical pharmacist availability and participation in multiprofessional ward rounds, while barriers included increased workload associated with the discharge intervention process.ConclusionsMulticomponent interventions based on education of staff and guidelines were effective at achieving almost four times more de-prescribing of inappropriate medication by the time of patient hospital discharge. Based on the findings, practice and policy recommendations are made and guidance is provided on the need for, and design of theory informed interventions in this area, including the requirement for process and economic evaluations.

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Critical care pharmacist group consensus on the most important medication error reduction resources was established. Pharmacists working on high-resourced units made more clinically significant medicines optimisations.

By reading this article you should be able to:Discuss the clinical significance of medication errors in anaesthesia. List the causes of medication errors, including human factors. Describe the role of medicine management systems in optimising medicines safety. Outline the aspects of clinical practice that anaesthetists can use to reduce the likelihood of medication errors occurring.Anaesthetic practice involves the preparation and administration of medicines with a high potential for harm in a timecritical fashion. The working environment is distracting and medicines are often used without the support of colleagues or electronic clinical decision tools. There is a reliance on situational awareness, mental focus, and vigilance in order to reduce the chance of medication errors (MEs) occurring. However, human errors are an inevitable outcome of poor human reliability; so it is essential that steps are taken to minimise errors and harm. Robust medicines management is essential for the safe and effective use of drugs by anaesthetists. Processes must be in place to enable reliable and timely access to drugs for clinical efficiency and emergency treatment, whilst also restricting access to mitigate drug misdirection and abuse. 1 This article reviews the medicine management systems and human factors relevant to medicines safety in anaesthetic practice. Classification of MEsMedication errors are 'a failure in the treatment process that lead to, or have the potential to lead to, harm to the patient'. 2 Classification of errors can be approached in a variety of ways, for example according to root cause or clinical outcome. In order to prioritise effectively those areas in need of risk mitigation strategies, critical incident reporting data can be used to identify trends in particular types of MEs. Some of the ways that errors can be categorised are listed in Table 1. Clinical significance of medicines safetyThe reported incidence of MEs in anaesthetic practice varies widely between studies, partly because of varying definitions and study methodologies. In studies that rely on anaesthetists Steve Webber FRCA in a consultant in anaesthesia and critical care at Sheffield Teaching Hospitals. His clinical interests are clinical governance and patient safety, critical care, and anaesthesia for urological surgery.