SESSION TITLE: Quality Improvement in the ICU I
SESSION TYPE: Original Investigation Slide
PRESENTED ON: Monday, October 28, 2013 at 01:45 PM - 03:15 PM
PURPOSE: Bronchodilators (BD) and acid blockers (AB) are often administered to ICU patients. Some data suggest that BD and AB are inadvertently continued even after discharge from hospital.
METHODS: Records of ICU patients were reviewed six months before and after the institution of electronic medication reconciliation (EMR). Prior to EMR, home medications were recorded on a reconciliation form at the time of admission and were available for review for continuation of hand written medication orders at the time of transfer and discharge. In the EMR system, home medications were entered into the electronic medical record. This form was present on the inpatient medication order screen at the time of transfer and discharge for reconciliation. Inappropriate BD or AB was defined as discharge on these medications with no clinical indication.
RESULTS: 219 patients’ records were reviewed prior to EMR and 203 charts after. There was no difference in age, gender, smoking, history of asthma or COPD, home BD or AB use, non-invasive ventilator use, or hospital/ICU length of stay before vs. after EMR. More patients received mechanical ventilation prior to EMR (56/219vs.32/203;p=0.01). There was no difference in BD-without-indication in the ICU (34/144vs.24/134;p=0.23) or at the time of discharge (9/34vs.8/24;p=0.57) before vs. after EMR. Similarly there was no difference in inappropriate-AB in low risk patients (34/55vs.21/37;p=0.63) or at the time of discharge (23/98vs.25/82;p=0.29) before vs. after EMR. Patients were continued on AB at the time of transfer to the medical floor equally in high-risk (46/49vs.34/37;p=0.72), intermediate-risk (11/12vs.15/18;p=0.48), or low-risk groups for gastric injury (28/29vs.13/15;p=0.22). Patients were equally likely to be transferred to the floor on inappropriate BD before vs. after EMR (30/30vs.17/17;p=0.99).
CONCLUSIONS: This study confirms that BD and AB are often prescribed, without indication, in ICU patients. Our specific form of EMR did not impact this phenomenon, which engenders risks to patients and unnecessary costs.
CLINICAL IMPLICATIONS: Future efforts must focus on medicine reconciliation during care transitions, to identify those medications that should be continued AND those which are no longer required.
DISCLOSURE: The following authors have nothing to disclose: Timothy Coyle, Constantine Manthous, D. Datta
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