Effect van medicatieverificatie door de apotheker op onbedoelde medicatiediscrepanties bij opname op en ontslag van de intensive care

BACKGROUND: The transfer of patients to and from the intensive care unit (ICU) is prone to medication errors.
OBJECTIVE: To study the effect of medication reconciliation by a pharmacist on the frequency and type of unintended medication discrepancies at admission to and discharge from the ICU?
DESIGN AND METHODS: A prospective intervention study with a pre- and post-design was carried out on the ICU of the Erasmus MC. The proportion of patients with one or more unintended medication discrepancies at admission to and discharge from the ICU was compared before and after the implementation of medication reconciliation by a pharmacist.
RESULTS: 159 patients were included during the pre-intervention phase and 129 patients during the post-intervention phase. The proportion of patients with at least one unintended medication discrepancy 24 hours after admission to the ICU was reduced from 48.4 to 13.4% (OR 0.16: CI95 0.09-0.30). At discharge from the ICU this proportion was reduced from 71.9 to 37.6% (OR 0.24; CI95 0.14-0.41). The most frequently occurring type of medication discrepancy was an omission, explaining 80.9% of the discrepancies at admission and 76.5% at discharge. The type of discrepancies at admission was not significantly different between the pre- and post-intervention phase. At discharge the frequency of dosing errors was significantly reduced from 10.9% to 1.4%.
CONCLUSION: Medication reconciliation by a pharmacist significantly reduces the proportion of unintended medication discrepancies at admission to and discharge from the ICU.