Unintended modifications of chronic medication due to admission to an intensive care unit.

Onderzoeksoutput: Meeting abstract (Journal)

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Background and Objective
Admission to an intensive care unit (ICU) may entail an elevated risk of drug discrepancies (DD) due to the focus of care on stabilization of the patient.
The objective of the study was to investigate whether an ICU stay leads to more DD's in particular with respect to chronic medication.
Design
Observational, prospective, controlled cohort study. At hospital admission, the medication history was documented by a pharmacist. For drugs administered during hospitalization and prescribed at discharge, physicians' medication records were consulted. For patients transferred from the ICU to another ward, and who were later discharged from the hospital, the medication list and the medication scheme in the discharge letter respectively, were compared with the pharmacist-acquired medication history with special focus on chronic drugs.
Setting
Two adult ICU's (study group) and one cardiologic care unit (control group) of a Belgian university hospital (UZ Brussel).
Main outcome measures
The percentage of patients with unintended DD and the incidence as well as the type of DD in chronic medication.
Results
The study group consisted of 24 patients and the control group of 12 patients. In the study group 67% of the patients had one or more discrepancies in the medication history vs. 83% in the control group. There was no statistically significant difference in the number of DD between the two groups (Mann-Whitney test; U=135,5; n1=24; n2=12; p=0,77; ?=0,05). The most common discrepancy was omission of a chronic medication.
At the time of transfer from the ICU to another medical ward, 83% of the patients had one or more DD. The most common discrepancy was again omission of a chronic medication.
At hospital discharge, the percentage of patients with unintended DD was remarkably higher for the study group (81%) than for the control group (55%). There were statistically significant more DD in the study group than in the control group (Mann-Whitney test; U=63,5; n1=21; n2=11; p=0,036; ?=0,05). The most common discrepancy was omission of a chronic medication in the discharge letter. The percentage of unintended DD at discharge due to the ICU stay was 36%.
Conclusions
The stay in an ICU leads to more unintended DD in chronic medication. Some discrepancies are solved during the further hospitalization, but an important number results in DD at hospital discharge. At transition periods, structural medication reconciliation is necessary to prevent drug discrepancies. The complete and accurate transfer of information between hospital health care providers, patients and health care providers at home is crucial to prevent drug related problems.
Originele taal-2English
Pagina's (van-tot)277
Aantal pagina's1
TijdschriftPharmacy World & Science
Volume32
StatusPublished - 13 mrt 2010
EvenementUnknown - Stockholm, Sweden
Duur: 21 sep 200925 sep 2009

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