Medication use optimization in critical care through a pharmacy morbidity, mortality, and improvement program

Abstract

Pharmacy‐led morbidity, mortality, and improvement (MMI) programs enhance practitioner education and improve patient‐safety culture. The impact of MMI programs on process improvement (PI) outcomes is lacking, particularly within critical care. The purpose of this retrospective report was to describe PI interventions from critical care medication errors evaluated through a pharmacy MMI program. Medication errors reported between June 2013 and August 2022 that occurred in an intensive care unit, emergency department, or procedural area were included. Error severity and potential were assessed using the National Coordinating Council for Medication Error Reporting and Prevention (NCC MERP) Medication Error Index and Harm Associated with Medication Error Classification (HAMEC), respectively. The primary outcome of PI interventions was classified as clinical update, operations change, pharmacy or hospital administration change, and/or informatics and technology (IT) updates. Electronic medical record (EMR) were further classified as best practice advisory, medication order build/change, order set build/change, dose limit/alert, or infusion smart pump change. Institute for Healthcare Improvement (IHI) reliability level was evaluated as a secondary outcome. A total of 54 errors were included. Most errors were classified as NCC MERP category D (13 [24.1%]) and C (12 [22.2%]) with severe harm potential (HAMEC 4, 26 [48.1%]; median score 3 [interquartile range, IQR, 3–4]) error potential. A total of 88 PI interventions were identified (median 1.5 [IQR 1–2] per error); clinical (30 [34.1%]) and IT (26 [29.5%]) updates were the most common. Order set build or change (20 [45.5%]) was the most common EMR enhancement. PI interventions were a median IHI level 1 reliability (IQR, 1–2). EMR enhancements had a median IHI level of reliability of 2 (IQR, 1–2). Critical care medication errors addressed through a formal Pharmacy MMI program have high harm potential and often involve multiple PI interventions. EMR interventions generally had higher levels of empiric reliability.

Continuing excellence in critical care pharmacy practice, education, and advocacy

“…7,8 Critical care pharmacist participation on the multidisciplinary team has also demonstrated considerable benefits in areas such as anticoagulation, 9,10 antimicrobial therapy, 11 pain, agitation and sleep management, [12][13][14] and overall medication safety. 15 The ICU Liberation Campaign represents bundled interventions conducted by an interdisciplinary team, including a critical care pharmacist that has been associated with improvement in survival, ICU length of stay, and ICU readmission. 16 The systematic review by Buckley et al 12 describes how pharmacist-led interventions in regards to pain, agitation, and delirium management were associated with a decrease time on mechanical ventilation and length of stay, as well as reductions in opioid analgesia and sedative use.…”