An audit of the continuation and review of intensive care unit (ICU)-initiated medications post ICU discharge

Abstract

Abstract Introduction Medication errors at transitions of care have widely been reported and the transition of a patient from intensive care unit (ICU) to ward level care has additional risk for error due to the complexity of the cohort. The continuation of ICU-initiated medications at ward level has been associated with adverse drug events, and error mitigation strategies need to be implemented at the point of discharge from ICU to facilitate deprescribing and medication optimisation. Pharmacists are in an excellent position to facilitate this medication optimisation at the point of ICU transfer. Aim This study aimed to evaluate the frequency that ICU-initiated medications are continued on discharge from ICU and subsequently reviewed at ward level in a large teaching hospital. Methods An audit was conducted as a prospective observational study over the period of June and July 2023. A pharmacist reviewed kardexes of patients that had been discharged from ICU to determine the prevalence of ICU-initiated medications that were continued post discharge. Medications continued were documented using an Excel spreadsheet on a password-protected computer. A pharmacist followed patients at day 7 post ICU discharge and an audit was conducted to document if these medications had been reviewed by primary teams. A medication was deemed to be reviewed by a primary team if discontinued on the kardex, a dose altered on the kardex or reference made to the medication in the medical notes. All patients discharged from ICU to ward level care were eligible to be included in the study. Results In total, 53 patients were eligible to be included in the study, of which 51 had ICU-initiated medications continued on discharge. No class of medication was found to be reviewed for all patients discharged on that class of medication. Over half of patients (52.9%) had stress ulcer prophylaxis medications continued, 39.2% had opioids continued and 33.3% had anti-delirium medications continued. No surgical patient had anti-delirium medications reviewed at ward level and surgical patients were found to be the largest cohort discharged on opioids but not reviewed at ward level. Conclusion This study has highlighted that not only are ICU-initiated mediations continued on discharge from ICU, but also that a high proportion of these medications are not reviewed at ward level by primary teams. This has further shown the requirement for pharmacist review and verification of kardexes prior to ICU discharge and the implementation of deprescribing protocols. The main limitation of the study was the small sample size of patients discharged from ICU during the study period. Future studies could focus on the impact that a pharmacist-led quality improvement initiative would have on the continuation and review of ICU-initiated medications on discharge from the ICU and the audit repeated over a longer period of time.