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

Background Medication 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 o...

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Bibliographic Details
Published in:	Annals of intensive care Vol. 8; no. 1; p. 19
Main Authors:	Bosma, Liesbeth B. E., Hunfeld, Nicole G. M., Quax, Rogier A. M., Meuwese, Edmé, Melief, Piet H. G. J., van Bommel, Jasper, Tan, SiokSwan, van Kranenburg, Maaike J., van den Bemt, Patricia M. L. A.
Format:	Journal Article
Language:	English
Published:	Cham Springer International Publishing 07-02-2018 SpringerOpen
Subjects:	5 September 2013 Adverse drug event Anesthesiology Cost–benefit analysis Critical Care Medicine Dutch trial register Emergency Medicine Intensive Intensive care unit Medication reconciliation Medicine Medicine & Public Health NTR4159 Pharmacist retrospectively registered Pharmacist Medication reconciliation Adverse drug event Intensive care unit Cost–benefit analysis
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Summary:	Background Medication 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. Methods This 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. Results In 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% (OR adj 0.18 [95% CI 0.11–0.30]) and after discharge from 73.9 to 41.2% (OR adj 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% (OR adj 0.13 [95% CI 0.07–0.24]) and after discharge from 69.5 to 36.2% (OR adj 0.26 [95% CI 0.17–0.40]). The pADE reduction resulted in a potential net cost–benefit of € 103 per patient. Conclusions Medication 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
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	2110-5820 2110-5820
DOI:	10.1186/s13613-018-0361-2