The effect of a medication reconciliation program in two intensive care units in the Netherlands: a prospective intervention study with a before and after design

Abstract

BackgroundMedication errors occur frequently in the intensive care unit (ICU) and during care transitions. Chronic medication is often temporarily stopped at the ICU. Unfortunately, when the patient improves, the restart of this medication is easily forgotten. Moreover, temporal ICU medication is often unintentionally continued after ICU discharge. Medication reconciliation could be useful to prevent such errors. Therefore, the aim of this study was to determine the effect of medication reconciliation at the ICU.MethodsThis prospective 8-month study with a pre- and post-design was carried out in two ICU settings in the Netherlands. Patients were included when they used ≥ 1 chronic medicine and when the ICU stay exceeded 24 h. The intervention consisted of medication reconciliation by pharmacists at the moment of ICU admission and prior to ICU discharge. Medication transfer errors (MTEs) were collected and the severity of potential harm of these MTEs was measured, based on a potential adverse drug event score (pADE = 0; 0.01; 0.1; 0.4; 0.6). Primary outcome measures were the proportions of patients with ≥ 1 MTE at ICU admission and after discharge. Secondary outcome measures were the proportions of patients with a pADE score ≥ 0.01 due to these MTEs, the severity of the pADEs and the associated costs. Odds ratio and 95% confidence intervals were calculated, by using a multivariate logistic regression analysis.ResultsIn the pre-intervention phase, 266 patients were included and 212 in the post-intervention phase. The proportion of patients with ≥ 1 MTE at ICU admission was reduced from 45.1 to 14.6% (ORadj 0.18 [95% CI 0.11–0.30]) and after discharge from 73.9 to 41.2% (ORadj 0.24 [95% CI 0.15–0.37]). The proportion of patients with a pADE ≥ 0.01 at ICU admission was reduced from 34.8 to 8.0% (ORadj 0.13 [95% CI 0.07–0.24]) and after discharge from 69.5 to 36.2% (ORadj 0.26 [95% CI 0.17–0.40]). The pADE reduction resulted in a potential net cost–benefit of € 103 per patient.ConclusionsMedication reconciliation by pharmacists at ICU transfers is an effective safety intervention, leading to a significant decrease in the number of MTE and a cost-effective reduction in potential harm.Trial registration Dutch trial register: NTR4159, 5 September 2013, retrospectively registered

Going back to the ward—transitioning care back to the ward team

“…Development of a structured medication reconciliation process, specifically at ICU discharge, could mitigate some of these preventable medication errors. In two adult ICUs in the Netherlands, medication reconciliation completed shortly before transfer of patients from the ICU to the ward, was associated with a decrease in medication transfer errors from 45% to 15% (16). In this study, the ICU physician and pharmacist created a "best possible ICU medication discharge list", which contained recommendations regarding timeline for continuation of new medications as well as a list of chronic pre-admission medications that were discontinued in the ICU.…”

Development of a multivariable prediction model for identification of patients at risk for medication transfer errors at ICU discharge

“…Discharging patients from an Intensive care unit (ICU) is a high-risk process prone to medication transfer errors (MTE) with a high potential for adverse drug events (ADE) [1]. Possible causes of MTE are multifactorial, relating to the system, the patient and the healthcare staff [2–4].…”

“…Medication reconciliation by an ICU pharmacist at ICU admission and discharge, reduces MTE and therefore patient harm [1]. Ideally, each hospital pharmacy would have the resources to provide this new medication safety practice to every ICU patient [1,8].…”

The impact of a medication reconciliation programme at geriatric hospital admission: A pre‐/postintervention study

“…1 In the Netherlands, medication reconciliation by pharmacists at intensive care unit transfers led to a significant decrease medication transfer errors and a cost-effective reduction in potential harm. 9 In England, the addition of pharmacists to healthcare teams would reduce morbidity and health care costs. 10 In South Africa, medication reconciliation practiced by multidisciplinary teams, including pharmacists, ensure continuity of patient care throughout patients' hospital stay to decrease adverse drug events.…”

“…The impact of medication reconciliation by healthcare professional on inpatient outcomes has been well demonstrated in some countries . In the Netherlands, medication reconciliation by pharmacists at intensive care unit transfers led to a significant decrease medication transfer errors and a cost‐effective reduction in potential harm . In England, the addition of pharmacists to healthcare teams would reduce morbidity and health care costs .…”