Reducing medication errors in critical care patients: pharmacist key resources and relationship with medicines optimisation

Bourne, Richard S; Shulman, Rob; Jennings, Jennifer K

doi:10.1111/ijpp.12430

Cited by 19 publications

(11 citation statements)

References 25 publications

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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 optimizations [ 9 ], [ 19 - 23 ].…”

Section: Pharmacists' Role In Critical Carementioning

confidence: 99%

Pharmacists in Critical Care

Mohiuddin

2019

Innov Pharm

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The beginnings of caring for critically ill patients date back to Florence Nightingale’s work during the Crimean War in 1854, but the subspecialty of critical care medicine is relatively young. The first US multidisciplinary intensive care unit (ICU) was established in 1958, and the American Board of Medical Subspecialties first recognized the subspecialty of critical care medicine in 1986. Critical care pharmacy services began around the 1970s, growing in the intervening 40 years to become one of the largest practice areas for clinical pharmacists, with its own section in the SCCM, the largest international professional organization in the field. During the next decade, pharmacy services expanded to various ICU settings (both adult and pediatric), the operating room, and the emergency department. In these settings, pharmacists established clinical practices consisting of therapeutic drug monitoring, nutrition support, and participation in patient care rounds. Pharmacists also developed efficient and safe drug delivery systems with the evolution of critical care pharmacy satellites and other innovative programs. In the 1980s, critical care pharmacists designed specialized training programs and increased participation in critical care organizations. The number of critical care residencies and fellowships doubled between the early 1980s and the late 1990s. Standards for critical care residency were developed, and directories of residencies and fellowships were published. In 1989, the Clinical Pharmacy and Pharmacology Section was formed within the Society of Critical Care Medicine, the largest international, multidisciplinary, multispecialty critical care organization. This recognition acknowledged that pharmacists are necessary and valuable members of the physician-led multidisciplinary team. The Society of Critical Care Medicine Guidelines for Critical Care Services and Personnel deem that pharmacists are essential for the delivery of quality care to critically ill patients. These guidelines recommend that a pharmacist monitor drug regimen for dosing, adverse reactions, drug-drug interactions, and cost optimization for all hospitals providing critical care services. The guidelines also advocate that a specialized, decentralized pharmacist provide expertise in nutrition support, cardiorespiratory resuscitation, and clinical research in academic medical centers providing comprehensive critical care. Article Type: Commentary

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Section: Pharmacists' Role In Critical Carementioning

confidence: 99%

Pharmacists in Critical Care

Mohiuddin

2019

Innov Pharm

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“…23 However, ICU medication-related discharge practices remain inconsistent. [24][25][26][27] Contributors to variation in practice include uncertainty over key intervention components and processes, 24 availability of important medicines optimisation resources 25 and staff communication failures 26 in the context of an important care interface. 6 Moreover, in isolation, the recommended handover procedure does not adequately address the challenges and complexity of patient care transitions including the importance of patient and family engagement, medicines reconciliation and medication review.…”

Section: Introductionmentioning

confidence: 99%

“…To mitigate this increased patient safety risk, the European Society of Intensive Care Medicine recommends use of a standardised handover procedure, including an explanation of medication changes and treatment plans, on patient transfer from ICU 23. However, ICU medication-related discharge practices remain inconsistent 24–27. Contributors to variation in practice include uncertainty over key intervention components and processes,24 availability of important medicines optimisation resources25 and staff communication failures26 in the context of an important care interface 6.…”

Section: Introductionmentioning

confidence: 99%

Medication-related interventions to improve medication safety and patient outcomes on transition from adult intensive care settings: a systematic review and meta-analysis

et al. 2022

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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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“…Despite the effect of patient safety on people health medical errors in health care continue to occur [3]. One of the most common medical errors is medication errors [4]. These errors occur due to patient misuse of medication or wrong administration of medication by health care providers and can lead to failure in treatment process and injury to the patient [5][6][7].…”

Section: Introductionmentioning

confidence: 99%

Need Assessment and Development of a Mobile-based Medication Dosage Calculation Application for ICU nurses

Abbasi¹,

Khajouei²,

Nejad³

et al. 2020

Preprint

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Background Medication dosage calculation errors are among the most common errors of nurses in intensive care unit (ICU). Information technologies, particularly mobile devices, can advance drug dosage calculation processes. The objective of this study was to develop a medication dosage calculation application for nurses in intensive care units. Methods This study was performed in the ICUs of teaching hospitals in Kerman University of Medical Sciences in 2018. First, a need assessment survey of nurses was conducted to determine the required features of the application. As well two specialists were interviewed to determine the medications used in the ICUs. Second, a medication dosage calculation application was developed using formative usability testing. Results Overall, 80% of the participants (n=120) answered the need assessment questionnaire. Of 29 features determined in the needs assessment, 19 were selected to develop the application. Moreover, 25 medications were selected by specialists and participants for the development of the application and its prototype. The usability test of the prototype found 15 problems. After fixing these problems 2 problems were identified, which were fixed in the final version. Conclusion According to the participants, development of the medication dosage calculation application increases the accuracy of drug dosage and reduces the errors. The user-identified features were developed in-app. User-centered usability testing in this study improved development based on needs of users. The method used in this study can be used by developers of health applications to develop applications which are consistent with user needs.

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Reducing medication errors in critical care patients: pharmacist key resources and relationship with medicines optimisation

Abstract: 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.

Cited by 19 publications

References 25 publications

Pharmacists in Critical Care

Pharmacists in Critical Care

Medication-related interventions to improve medication safety and patient outcomes on transition from adult intensive care settings: a systematic review and meta-analysis

Need Assessment and Development of a Mobile-based Medication Dosage Calculation Application for ICU nurses

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