Abstract & Overview
Background and Importance Medication errors during a hospital stay can endanger patient safety, prolong the patients hospital stay and even be fatal. The critically ill patients in the intensive care unit (ICU) are particularly vulnerable to errors in medication management, and each care transition increases the risk of medication discrepancies. Aim and Objectives The aims of the study were 1) to develop a workflow for clinical pharmacist to become an integral part of the multidisciplinary ICU team, 2) to perform a pharmacist-led intervention to improve the documentation of medication lists, optimise medical treatment and avoid drug-related problems (DRPs). Material and Methods A preintervention retrospective control cohort at the ICU (n=34) was used to assess the effect of pharmacist-led intervention. Clinical pharmacist registered medication information about the patients before admission to ICU, quality score of the medication information in the admission records, medication information when patients were transferred in-hospital, and in the discharge summary. Additional in the pharmacist-led intervention (n=23) medication reconciliation and drug review were performed. Results Clinical pharmacist found discrepancies in medication information and/or electronic prescribing for 55 different drugs (n=19 patients, 82%), in average 2.4 drugs per patient. Most common discrepancies were drugs missing (n=25, 45%), important information about poor compliance were missing (n=12, 22%) and drugs no longer in use were listed in medication information and/or electronic prescription (n=10, 18%). Most of the patients (n=20, 87%) had DRPs or potentially DRPs, in total 85 DRPs. Most commonly DRPs included drugs needed monitoring (n= 16, 19%) and drugs were found unnecessary for patient (n=15, 18%). The ATC group N including central nervous agents like anxiolytics, hypnotics and sedatives, antipsychotics and antidepressants were commonly related to the DRPs or potentially DRPs (n=26, 31%). The average quality score of medication information in discharge summery were higher in the intervention group (n=18, score: 11.5) compared to the control group (n=31, score: 8.3). Maximum score is 21. Conclusion and Relevance In an ICU multidisciplinary team, clinical pharmacist should be integral part to increase patient safety. The clinical pharmacist contributed to less medication errors and DRPs and improved documentation of the medication lists throughout the hospital stay. References and/or Acknowledgements Conflict of Interest No conflict of interest.