Could post-ICU medication review improve patient safety?

29^th EAHP Congress highlights

Medication review, with input from pharmacy, is a national standard for post- intensive care (ICU) follow-up, set out in the Guidelines for the Provision of Intensive Care Services (GPICS).¹ The guidelines note that “There is good evidence that the direct inclusion of pharmacists within the multi-professional team reduces medication errors and improves patient outcomes by enhancing and individualising medication therapy while reducing costs”. However, according to one recent study, just 21% of UK ICU pharmacy teams provide input at transfer of care.²

Lamb and colleagues (University Hospitals, Plymouth) described a study that investigated the impact of specialist pharmacist medication reviews for patients transferred from intensive care units (ICUs) to general wards.³

In a prospective study, they evaluated the records of 134 (75 in person, 59 remotely) patients discharged from an ICU to a ward over a period of 5 days in June 2023. Pharmacists made 344 interventions in 106 (79%) patients. A total of 28 interventions prevented potential moderate harm and eight interventions prevented potential serious harm. This latter group included incorrect doses of anticoagulants, inadvertent cessation of antimicrobials and absence of therapeutic drug monitoring in high-risk medications. Antibiotics and anticoagulants were the most-commonly implicated classes of medications.

This study shows that medication errors are common during this transition and more prevalent than reported in a large non-UK study.⁴ The findings suggest a gap between national standards recommending pharmacy input and the current level of pharmacist involvement in post-ICU care. The authors conclude that medication review by a specialist pharmacist has the potential to reduce harm from medications in patients recently discharged from ICU. Further work should focus on the feasibility and cost-effectiveness of implementing this service.

References

1. McNaughton P, 2022. Guidelines for the Provision of Intensive Care Services. Faculty of Intensive Care Medicine. https://www.ficm.ac.uk/sites/ficm/files/documents/2022-07/GPICS%20V2.1%20%282%29.pdf
2. Faculty of Intensive Care Medicine (2021) Life After Critical Illness. https://www.ficm.ac.uk/sites/ficm/files/documents/2021-12/LACI%20Life%20After%20Critical%20Illness%202021.pdf
3. Lamb J, Mitchell A, Farrell O. Assessing the impact of specialist pharmacist Review on the safety of medications in patients recently discharged from intensive care. (Poster) EAHP Congress 2025
4. Wang Y, Zhang X, Hu X, et al. Evaluation of medication risk at the transition of care: a cross-sectional study of patients from the ICU to the non-ICU setting. BMJ Open 2022;12:e049695. doi:10.1136/ bmjopen-2021-049695