Daniella Abi Kheir, PharmD: No relevant financial relationship(s) to disclose.
Introduction: During transition out of the ICU, 45.7% of patients had a medication error with the most common errors as the continuation of ICU specific medications or untreated conditions. These errors could lead to readmissions, medication adverse effects and increased costs. Due to limited guidance on best practices, this study was conducted to evaluate the incidence of medication errors with a pharmacy intervention compared to current practice.
Methods: This retrospective, single center pre-post cohort of a pharmacy intervention included adult patients that transitioned out of a surgical ICU, excluding those in hospice or that expired. The primary outcome was the number of patients with at least one error. Literature found a 40% error reduction with a pharmacist intervention, and we chose a conservative estimate of a 20% reduction with a 25% error incidence. A sample size of 120 patients was calculated for an alpha of 0.05 and power of 80%. Secondary outcomes were length of stay, readmission rate and cost. Categorical and continuous data were analyzed using a chi-squared test and Mann-Whitney U test respectively.
Results: Baseline characteristics were similar in both groups. Without the intervention, 55% of patients experienced an error, compared to 18.3% of patients with the intervention (p < 0.001), including ICU specific medication errors (20% vs 6.7%; p 0.035) or the inappropriate discontinuation of at least one chronic home medication (48.3% vs 13.6%; p< 0.001). Stress ulcer prophylaxis was continued in 18.3% of patients compared to 3.4% of patients without the intervention (p 0.009). Inpatient ICU medication cost difference between groups was $280 in 4 months. At discharge, 20% of patients were prescribed ICU medications compared to 7% with the intervention (p 0.041). Other outcomes before and after the intervention were length of stay in days (9 vs 9.5; p 0.285), readmission rate (36.7% vs 27.6%; p 0.291), and other errors on discharge (28.3% vs 19.3%; p 0.252) respectively.
Conclusions: Implementation of a pharmacy intervention significantly reduced the number of patients with medication errors during transition out of the ICU. This adds to the limited literature on the pharmacist’s impact and highlights the need for a dedicated transitions of care pharmacy service to promote patient safety.
