Investigation of Medication Errors in Intensive Care Units

Link to EAHP Statements

• Section 4 – Clinical Pharmacy Services: Statements – 4.1, 4.2, 4.3, 4.4, 4.5, 4.6, 4.7, 4.8
• Section 5 – Patient Safety and Quality Assurance: Statements – 5.1, 5.2, 5.4, 5.5, 5.6, 5.7, 5.8, 5.9, 5.10, 5.11

ACPE Non-Accredited Activity

Abstract

Background:

Medication 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. Risk factors contributing towards MEs and strategies that could prevent them and improve medication safety have been identified. Little is known about which ME prevention strategies are in use in ICUs across Europe.

Aim:

To develop and prioritise policy recommendations to support medication safety improvement in ICUs across Europe. 

Methods:

This study comprised: a literature review, a survey, focus group discussions and a Delphi panel. Ethical approvals were sought; participation was voluntary and confidential.

An online cross-sectional descriptive survey was developed based on the reviewed literature. In March-April 2022, the anonymous survey was distributed to healthcare professionals (HCPs) working in European ICUs. Descriptive analysis was employed. A topic guide was developed for focus group discussions based on the literature and survey analysis. Medication safety officers or HCPs working in ICUs across Europe were invited to participate. In May 2022, discussions were conducted online, recorded, transcribed, and analysed. The preliminary policy recommendations were based on the literature, the survey and the focus group discussion analysis. At round 1 in October 2022, the Delphi panel, formed by 21 EAHP Special Interest Group (SIG) members, anonymously prioritised the recommendations. At round 2 in November-December 2022, recommendations without consensus were included. The data were analysed for degree of priority.

Results:

In total, 587 healthcare professionals from 32 European countries responded to the survey. Among ME prevention strategies in use in ICUs, the respondents reported having: a standardised process for taking medication histories for all patients (31%); computerised physician order entry or electronic prescribing systems for all orders and patients (53%); an allocated pharmacist (31%); medication review at discharge (19%); an incident reporting system (77%). Three nurses and 11 pharmacists, working in seven European countries, participated in focus group discussions. Facilitators for medication safety were e.g. engaging and communicating with HCPs in improving medication safety, providing feedback on MEs and ME prevention strategies (n=31), interprofessional working in an environment without hierarchies (n=27), and having a ‘good’ culture and environment (n=25). A lack of engagement of HCPs and their attitudes towards medication safety (n=37), and an existing blame culture (n=34) were mentioned among the barriers to medication safety. The 25 ME prevention strategies included assessing knowledge and auditing practice and learning, teaching and training (n=34), incident reporting (n=31), and pharmacists working in ICUs and participating in ward rounds (n=30).

In total, 32 policy recommendations were developed. At Delphi Round 1, 19 HCPs participated; consensus was achieved on most recommendations and partial consensus on six. At Round 2, up to 18 HCPs participated. After two Delphi rounds, consensus was achieved on 31 recommendations, and partial consensus on one. All recommendations were considered ‘high priority’ except one (‘medium priority’).

Conclusion:

Through this study it was possible to develop and prioritise policy recommendations to enhance medication safety which may contribute to reducing medication errors in ICUs across Europe.

Learning objectives 

After the session, participants should be able:

• To recognise medication safety prevention strategies implemented in their ICUs;
• To indicate recommended medication safety prevention strategies that should be implemented in their ICUs;
• To outline the SIG policy recommendations for medication safety development within the ICU environment across Europe.

Educational need addressed 

This seminar discusses the policy recommendations developed by the SIG to reduce medication errors in ICUs across Europe.

Keywords: Medication safety, patient safety, medication errors, intensive care units, critical care