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Abstract

Introduction: Medication safety is crucial for critically ill patients with organ dysfunction exposed to polypharmacy. Our objective was to test an ‘Inventory for Medication Safety Interventions in the ICU’ (IMSI-ICU), developed based on a systematic review of strategies that impact on medication safety through error reduction, enhanced communication or institutional culture change. Hypothesis: We hypothesized that community and academic colleagues would find it to have face validity, and be easy to use, clear, complete, sensible, and reproducible. Methods: Preliminary drafts of the IMSI-ICU were created by medication safety experts from medicine, pharmacy, and nursing from ISMP Canada, ISMP US, McMaster University, University of Toronto, and Johns Hopkins University. For piloting testing, the IMSI-ICU was reviewed by 12 experts (3 pharmacists [Ph], 4 nurses [RNs], 4 physicians [MDs] and 1 ICU manager). Respondents were asked to provide feedback on item wording, flow, organization, and ease of completion. Formal clinical sensibility testing was completed by 1 Ph, 2 RNs, 5 MDs, and 1 manager using a 1 to 5 scale. For the test-retest exercise, the IMSI-ICU was administered 2 weeks apart to 16 persons in 4 centers in 3 cities. Results: Comments were favourable; pilot testing feedback was to shorten instructions, clarify item stems, allow selection of ‘unsure’, and provide examples, which resulted in a modified 44 item IMSI-ICU instrument. Clinical sensibility mean scores indicated that the items were important (4.6), complete (4.3), understandable (4.1), suitable (4.6), not redundant (4.7), and potentially discriminable (3.6). Of the 704 test-retest paired data points, 108 pairs had different responses, although most were mismatched by only 1 category and 23 pairs were mismatched by >1 category. Conclusions: The IMSI-ICU is a novel instrument for measuring effective medication safety interventions in practice. This 3 phase testing suggests that the IMSI-ICU has been pre-tested, is clinically sensible and reliable, and is ready to be completed by a multidisciplinary ICU team to examine its responsiveness in multicenter studies.