Transition of care from adult intensive care settings – implementing interventions to improve medication safety and patient outcomes

McCarthy, Suzanne; Laaksonen, Raisa; Silvari, Virginia

doi:10.1136/bmjqs-2021-014443

Cited by 3 publications

(4 citation statements)

References 22 publications

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“…Reasons for this include the complexity of some of the proposed interventions, particularly those which are technology-based. Not only is successful implementation of these a significant undertaking requiring significant resources, but achieving and demonstrating intended benefits is also complex and difficult 31. The potential for unintended consequences and implications of changes in workflow also require consideration 32.…”

Section: Discussionmentioning

confidence: 99%

Development and prioritisation of policy recommendations for medication safety improvement for intensive care units: a European Association of Hospital Pharmacists Special Interest Group Delphi Study

Howlett,

McCarthy,

Silvari

et al. 2024

Eur J Hosp Pharm

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ObjectivesMedication errors (MEs) are a leading cause of morbidity and mortality in the healthcare system. Patients admitted to intensive care units (ICUs) are potentially more susceptible to MEs due to severity of illness, the complexity of treatments they receive and the challenging nature of the ICU setting. The European Association of Hospital Pharmacists established a Special Interest Group (SIG) to undertake a programme of work to develop and prioritise recommendations to support medication safety improvement in ICUs across Europe.MethodsInitial policy recommendations for medication safety within the ICU environment were developed following reviews of the literature and engagement with relevant stakeholders. A Delphi panel of 21 members of the SIG, that comprised healthcare professionals (HCPs) with expertise in ICU and/or medication safety, was convened in 2022. We conducted two rounds using a modified Delphi technique whereby participants anonymously ranked on a 9-point Likert Scale the policy recommendations according to their priority for implementation.ResultsIn total, 32 policy recommendations were developed. In Delphi Round 1, 19 HCPs participated; consensus was achieved on most recommendations and partial consensus on six. In Delphi Round 2, 18 HCPs participated. After two Delphi rounds, consensus was achieved on all 32 recommendations. All recommendations were considered ‘high priority’ except one that was considered ‘medium priority’.ConclusionsThrough this study it was possible to develop and prioritise evidence-based policy recommendations to enhance medication safety, which may contribute to reducing MEs in ICUs across Europe. All recommendations were considered ‘high priority’ for implementation except one, indicating the perceived value of these recommendations in improving medication safety through preventing MEs in ICUs.

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Section: Discussionmentioning

confidence: 99%

Development and prioritisation of policy recommendations for medication safety improvement for intensive care units: a European Association of Hospital Pharmacists Special Interest Group Delphi Study

Howlett,

McCarthy,

Silvari

et al. 2024

Eur J Hosp Pharm

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“… 36 The intervention was delivered by research nurses, and implementation in routine clinical practice in critical care would have the known challenges. 37 Rosgen et al 16 undertook a qualitative analysis of HCPs’, patients’, and family members’ considerations for a transition in care bundle. They identified the need to increase engagement with patients and family members around existing transition in care tools and the need for direct discussion and follow-up transfer summaries.…”

Section: Discussionmentioning

confidence: 99%

Qualitative Insights Into Patients' and Family Members’ Experiences of In-Hospital Medication Management After a Critical Care Episode

Bourne,

Jeffries,

Meakin

et al. 2024

CHEST Critical Care

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“…The substantial number of intervention components agreed presents obvious challenges for effective implementation in any evaluation of a complex intervention [ 12 ]. It is important to minimize any redundancy within the intervention package, avoiding unnecessary duplication of work (e.g.…”

Section: Discussionmentioning

confidence: 99%

“…These are important deficiencies when a complex intervention package is likely to be required to impact on medication safety, acknowledging the complexity of the ICU patient to ward transfer [ 7 , 10 ]. Routine delivery of such complex interventions in hospital practice requires meaningful and early engagement with appropriate health-care professional stakeholder groups, patients, families or carers to ensure that the intervention is acceptable and implementable at scale across differing system contexts [ 11 , 12 ]. The development and identification of a complex intervention is needed to improve its validity and reduce the potential for research waste [ 13 ].…”

Section: Introductionmentioning

confidence: 99%

A Delphi consensus study to identify priorities for improving and measuring medication safety for intensive care patients on transfer to a hospital ward

Bourne

Jennings

Ashcroft

2022

International Journal for Quality in Health Care

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Background Intensive care patients surviving to transfer to a lower-acuity hospital ward experience ongoing challenges to their recovery and lack a well-defined and developed care pathway. The transfer process to a hospital ward exposes intensive care patients to high-rates of medication errors, that increase their risk of adverse drug events. The aims of this study were to identify priorities for medication-related intervention components and outcome measures, for improving medication safety for intensive care patients transferring to a hospital ward. Methods Three panels involving 129 participants covering (i) intensive care and, (ii) hospital-ward healthcare professionals and, (iii) public representatives completed an electronic Delphi survey conducted over three phases. The Delphi process comprised of three sections (medication-related intervention components, medication outcomes and patient outcomes). Items were graded in their level of importance, with predefined important criteria. Item agreement required consensus across all three panels. Intervention barriers and facilitators identified in participant comments were categorised according to a socio-technical systems approach to the patient journey and patient safety (Systems Engineering Initiative for Patient Safety 3.0 model). Results One-hundred and nine of the 129 (84.5%) of participants completed all three Delphi phases. Consensus was achieved for 48 intervention components, 13 medication outcome measures and 11 patient outcome measures. Phase One provided 158 comments comprising of more than 200 individual barriers and facilitators to intervention delivery. Frequently cited facilitators included: Clearly specified roles and responsibilities (10.7% (Organisational conditions)), Patient and family as agents (8.8% (Care Team)), Medicines-related information easily accessible (7.8% (Tools and Technologies), and Clear medication plan and communication (7.3% (Tasks)). Conclusion Our findings provide identification of priorities for medication-related intervention components to improve medication safety for intensive care patients transferring to a hospital ward. Prioritisation is complemented by the identification and socio-technical categorisation of barriers and facilitators to intervention delivery. The identified important medication and patient outcomes to measure will inform the design of a future patient medication safety intervention study.

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Transition of care from adult intensive care settings – implementing interventions to improve medication safety and patient outcomes

Cited by 3 publications

References 22 publications

Development and prioritisation of policy recommendations for medication safety improvement for intensive care units: a European Association of Hospital Pharmacists Special Interest Group Delphi Study

Development and prioritisation of policy recommendations for medication safety improvement for intensive care units: a European Association of Hospital Pharmacists Special Interest Group Delphi Study

Qualitative Insights Into Patients' and Family Members’ Experiences of In-Hospital Medication Management After a Critical Care Episode

A Delphi consensus study to identify priorities for improving and measuring medication safety for intensive care patients on transfer to a hospital ward

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