(968) Medication Therapy Problems in Adult Critically Ill Patients: A Scoping Review

Introduction: Critically ill patients often require complex medication regimens which are sources of possible medication therapy problems (MTPs). The identification, prevention, and management of potential or actual MTPs are crucial due to significant impact of preventable drug-related morbidity and mortality worldwide. This scoping review sought to summarize the current literature about MTPs in the ICU to serve as a valuable resource for clinicians and educators working to improve medication safety and patient outcomes in critical care environments.

Methods: PubMed and Embase were searched for studies using terms related to MTPs and critically ill patients. Studies of ICU survivors and drug-related admission were excluded along with non-English and non-original research. Citations were screened using a two-phase, two-reviewer process and reporting followed the PRISMA extension for scoping reviews.

Results: After deduplication, 456 citations were screened from which 42 studies of adult ICU patients were included. Included studies were published from 1996-2024, representing 5/6 WHO regions. A range of ICU types were included including medical (n=16), surgical (n=10), and trauma (n=6), 11 studies did not specify the ICU type, and 10 studies included multiple ICUs. 14 studies utilized a version of the Pharmaceutical Care Network Europe MTP framework while 20 used locally developed tools. Much heterogeneity existed among studies, especially with respect to how MTPs were reported, however, drug choice/selection MTPs accounted for 47% of all reported MTPs followed by dosing MTPs (29%). Few studies reported specific drugs/drug classes responsible for MTPs.

Conclusions: These findings emphasize the critical role of consistent and comprehensive reporting to improve medication safety and patient outcomes in ICU settings. Enhancing understanding of common MTPs can significantly contribute to reducing preventable medication-related harm in critical care environments. Future research should focus on identifying specific drugs or drug classes responsible for MTPs, developing unified reporting standards to enhance the comparability and applicability of study results, and integrating these insights into comprehensive educational programs for healthcare professionals working in ICU settings.