Medication safety for intensive care patients transferring to a hospital ward: A Hierarchical Task Analysis

Bourne, Richard S; Phipps, Denham L.; Jennings, Jennifer K; Boxall, Emma; Wilson, Franki; March, Helen; Ashcroft, Darren M.

doi:10.1016/j.hfh.2022.100030

Cited by 3 publications

(3 citation statements)

References 34 publications

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“…These e-prescribing systems must have the required functionality (including automation when applicable), to support delivery of medication safety, being informed by an understanding of the information and actions required to effectively undertake component tasks. 26 Patient flow systems across the ICU to ward transfer interface should be reviewed and optimised, to identify and implement modifiable elements to maximise multiprofessional team processes and care continuity within existing time constraints. Inter team communication processes around medication-information need to be streamlined, automated (when possible), co-ordinated and accessible, with structured modes of delivery.…”

Section: Discussionmentioning

confidence: 99%

“…Hospital-wide integration of e-prescribing systems across ICU and the hospital ward areas is imperative across this interface in patient care. These e-prescribing systems must have the required functionality (including automation when applicable), to support delivery of medication safety, being informed by an understanding of the information and actions required to effectively undertake component tasks 26. Patient flow systems across the ICU to ward transfer interface should be reviewed and optimised, to identify and implement modifiable elements to maximise multiprofessional team processes and care continuity within existing time constraints.…”

Section: Discussionmentioning

confidence: 99%

“…Simple interventions, based on staff education and guidelines, have been demonstrated to reduce the risk of inappropriate continuation of acute medication no longer indicated 25. The more complex, and higher clinic risk, of failure to restart clinically important long-term medication, will require a more complex intervention package 25–27…”

Section: Introductionmentioning

confidence: 99%

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Understanding medication safety involving patient transfer from intensive care to hospital ward: a qualitative sociotechnical factor study

et al. 2023

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ObjectiveTo understand the sociotechnical factors affecting medication safety when intensive care patients are transferred to a hospital ward. Consideration of these medication safety factors would provide a theoretical basis, on which future interventions can be developed and evaluated to improve patient care.DesignQualitative study using semistructured interviews of intensive care and hospital ward-based healthcare professionals. Transcripts were anonymised prior to thematic analysis using the London Protocol and Systems Engineering in Patient Safety V.3.0 model frameworks.SettingFour north of England National Health Service hospitals. All hospitals used electronic prescribing in intensive care and hospital ward settings.ParticipantsIntensive care and hospital ward healthcare professionals (intensive care medical staff, advanced practitioners, pharmacists and outreach team members; ward-based medical staff and clinical pharmacists).ResultsTwenty-two healthcare professionals were interviewed. We identified 13 factors within five broad themes, describing the interactions that most strongly influenced the performance of the intensive care to hospital ward system interface. The themes were: Complexity of process performance and interactions; Time pressures and considerations; Communication processes and challenges; Technology and systems and Beliefs about consequences for the patient and organisation.ConclusionsThe complexity of the interactions on the system performance and time dependency was clear. We make several recommendations for policy change and further research based on improving: availability of hospital-wide integrated and functional electronic prescribing systems, patient flow systems, sufficient multiprofessional critical care staffing, knowledge and skills of staff, team performance, communication and collaboration and patient and family engagement.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Understanding medication safety involving patient transfer from intensive care to hospital ward: a qualitative sociotechnical factor study

et al. 2023

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Association between critical care admission and chronic medication discontinuation post-hospital discharge: A retrospective cohort study

Kanodia,

Bourne,

Mansi

et al. 2024

Journal of the Intensive Care Society

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Background: Discontinuation of important chronic medication after hospitalisation is common. This study aimed to investigate the association between critical care (vs non-critical care) admission and discontinuation of chronic medications post-hospital discharge, along with factors associated with discontinuation among critical care survivors. Methods: This was a retrospective cohort study in Lothian, Scotland of adults who were admitted to hospital between 01/01/2012 and 31/12/2019 and survived to hospital discharge. Medication classes investigated were statins, angiotensin converting enzyme inhibitors/angiotensin receptor blockers (ACEi/ARBs), beta-blockers, oral anticoagulants, and thyroid hormones. The risk of medication discontinuation for each class was estimated by odds ratios (OR), with 95% confidence intervals (95%CI), using multivariable logistic regression adjusted for patient demographics, main clinical condition, and index comorbidity. A secondary analysis assessed factors associated with discontinuation in critical care survivors. Results: There were 22,340 critical care and 367,185 non-critical care survivors included. Critical care admission had the highest association with ACEi/ARBs discontinuation (adjusted OR 2.41, 95%CI: 2.26–2.58), followed by oral anticoagulants (adjusted OR 1.33, 95%CI: 1.15–1.53), and beta blockers (adjusted OR 1.18, 95%CI: 1.07–1.29). There was no significant association with thyroid hormones or statin discontinuation. Among critical care survivors, hospital length of stay of 14 days or more was associated with increased discontinuation across all medication classes. Conclusion: Critical care admission was associated with discontinuation of three out of five medication classes studied (ACEi/ARBs, beta-blockers, and oral anticoagulants). Further research is needed to understand the reason for increased medication discontinuation in critical care survivors and how these risks can be mitigated to improve patient outcomes.

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Improving medication safety for intensive care patients transitioning to a hospital ward: development of a theory-informed intervention package

Bourne,

Jeffries,

Jennings

et al. 2024

BMC Health Serv Res

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Background Care of critically ill patients is complex, requiring effective collaboration co-ordination and communication across care teams and professions. Medicines are a fundamental component of the acute interventions intensive care unit (ICU) patients receive, requiring frequent review and optimisation according to patient needs. ICU patients recovering to transfer to a hospital ward are at risk of medication transition errors, contributing to poorer patient and health-system outcomes. We aimed to develop of a theory-informed intervention package to improve medication safety for ICU patients transferring to a hospital ward. Methods We conducted a qualitative study comprising two UK face-to-face focus group meetings in April and May 2022. There were ten participants in each meeting (7-8 healthcare professionals and 2-3 patient and public representatives). Each meeting had four foci: (i) What needs to change (intervention targets)? (ii) What are the core intervention components? (iii) What will the intervention components change and how (mechanisms of action), and what key outcomes will the changes impact on? (iv) What are the barriers and facilitators to intervention delivery? A background to the problem and previous intervention development work was provided. Meetings were digitally recorded and transcribed verbatim. Iterative analyses, informed by the Behaviour Change Wheel framework, were conducted to provide a behavioural diagnosis, identify key behaviour change techniques and outline the mechanisms of action through which the intervention might impact on key outcome. Results We identified what needs to change to improve medication safety for UK ICU patients on this care transition. A theory-informed intervention package was developed, based on seven core intervention components (e.g., medication review (targeted), task organisation and prioritisation). For each intervention component the mechanism of action, targeted change, and key outcomes were identified (e.g., medication review (targeted); action planning; decreases problematic polypharmacy; decreased preventable adverse drug events). Barriers and facilitators to intervention component delivery were described. Conclusions We developed a theory-informed core intervention package to address the limitations in medication safety for ICU patients transferring to a hospital ward. Understanding what needs to change, and the accompanying facilitators provides a basis for intervention feasibility testing and refinement prior to future evaluation of effectiveness.

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Medication safety for intensive care patients transferring to a hospital ward: A Hierarchical Task Analysis

Cited by 3 publications

References 34 publications

Understanding medication safety involving patient transfer from intensive care to hospital ward: a qualitative sociotechnical factor study

Understanding medication safety involving patient transfer from intensive care to hospital ward: a qualitative sociotechnical factor study

Association between critical care admission and chronic medication discontinuation post-hospital discharge: A retrospective cohort study

Improving medication safety for intensive care patients transitioning to a hospital ward: development of a theory-informed intervention package

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