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Pharmacy impact on medication reconciliation in the medical intensive care unit
Brittany M Wills1, William Darko2, Robert Seabury2
1Nesbitt School of Pharmacy, Wilkes University, Wilkes-Barre, PA, USA.
Objective:
Pharmacy-driven medication history (MH) programs have been shown to reduce the number of serious or potentially life-threatening (S/PLT) medication discrepancies (MDs) in many settings, but not Intensive Care Units (ICUs).
Methods:
MHs were repeated over a 6-week period. Demographics, number, and nature of MDs were documented. Discrepancy severity was graded using a previously published method. Primary outcome was the proportion of MHs containing >1 S/PLT MDs.
Findings:
Sixty-three MHs were repeated. Pharmacy MHs were less likely to contain ≥1 S/PLT MDs (0% vs. 50%, P < 0.001).
Conclusion:
Pharmacy MHs contained fewer S/PLT MDs in this small sample. S/PLT MDs on admission and home medication lists were common in patients admitted to the medical ICU. Pharmacy-driven medication reconciliation (MR) reduced the number and frequency of these discrepancies. Further research is required to improve current MR procedures.
Insights
Pharmacy medication histories significantly reduced serious medication discrepancies in ICUs. This study highlights the effectiveness of pharmacy-driven medication reconciliation in critical care settings.
Area of Science:
- Medical Sciences
- Clinical Pharmacy
- Patient Safety
Background:
- Pharmacy-driven medication history (MH) programs are effective in reducing serious or potentially life-threatening (S/PLT) medication discrepancies (MDs) in various healthcare settings.
- However, their impact in Intensive Care Units (ICUs) has been less established.
Purpose of the Study:
- To evaluate the effectiveness of pharmacy-driven medication history (MH) programs in reducing S/PLT medication discrepancies (MDs) specifically within an Intensive Care Unit (ICU) setting.
- To assess the frequency and nature of MDs in patients admitted to the medical ICU.
Main Methods:
- A 6-week study involving repeated medication histories (MHs).
- Documentation of patient demographics, number, and nature of medication discrepancies (MDs).
- Grading of discrepancy severity using a validated method; primary outcome was the proportion of MHs with >1 S/PLT MDs.
Main Results:
- Sixty-three repeated MHs were analyzed.
- Pharmacy-led MHs demonstrated a significant reduction in S/PLT MDs, with 0% containing ≥1 S/PLT MDs compared to 50% in non-pharmacy MHs (P < 0.001).
Conclusions:
- Pharmacy-driven medication histories significantly decreased S/PLT MDs in this sample of ICU patients.
- Serious medication discrepancies were common upon admission and on home medication lists for ICU patients.
- Pharmacy-driven medication reconciliation (MR) proved effective in reducing the number and frequency of these critical discrepancies, though further research is needed to optimize MR procedures.
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