Effect of Inpatient Pharmacist-Led Medication Reconciliations on Medication-Related Interventions in Intensive Care...

Background: Critical care pharmacists complete comprehensive medication reviews in Post Intensive Care Syndrome (PICS) patients at Intensive Care Unit Recovery Centers (ICU-RCs) to optimize medication therapies after hospital discharge. Inpatient pharmacists often complete medication reconciliations prior to hospital discharge, which could affect interventions at an ICU-RC. However, this association remains ill-described. Objective: The purpose of this study was to, in patients with PICS, describe the effect of an inpatient, pharmacist-led medication reconciliation on the number of clinical pharmacist interventions at the first ICU-RC visit. Methods: This was a post-hoc subgroup analysis of an international, multicenter cohort study of adults who had a pharmacist-led comprehensive medication reconciliation conducted in 12 ICU-RCs. Only patients' first ICU-RC visit was eligible for inclusion. The primary outcome was the number of medication interventions made at initial ICU-RC visit in PICS patients who had an inpatient, pharmacist-led medication reconciliation compared to those who did not. Results: Of 323 patients included, 83 received inpatient medication reconciliations and 240 did not. No difference was observed in the median number of medication interventions between groups (2 vs 2, p = .06). However, a higher incidence of any intervention (86.3% vs 78.3%, p = .09) and dose adjustment (20.4% vs 9.6%; p = .03) was observed in the no medication reconciliation group. Only ICU Sequential Organ Failure Assessment score was associated with an increased odds of medication intervention at ICU-RC visit (aOR 1.15, 95% CI 1.05-1.25, p < .01). Conclusion and Relevance: No difference in the total number of medication interventions made by ICU-RC clinical pharmacists was observed in patients who received an inpatient, pharmacist-led medication reconciliation before hospital discharge compared to those who did not. Still, clinical observations within this study highlight the continued importance and study of clinical pharmacist involvement during transitions of care, including ICU-RC visits.