Background Discharge of patients from the intensive care unit (ICU) to a hospital ward is one of the most high risk transitions of care. Discrepancies in medication regimens at transfer may lead to medication errors and consequently adverse drug events.

Purpose To examine the prevalence and types of medication discrepancies during ICU to ward transfer.

Material and methods We conducted a 6 week prospective baseline evaluation of medication discrepancies on transfer. All adult ICU patients to be discharged from our 18 bed mixed surgical-medical ICU were eligible for inclusion. Medication discrepancies were defined as changes in drug therapy not documented on the transfer notes. Discrepancies were identified through assessment and comparison of the actual transfer notes with medication history and medication administration records during ICU stay. A classification system was adapted to systematically characterise the identified discrepancies.¹

Results Transfer notes of 30 patients (mean age 65.5 years, mean length of stay on ICU 4.1 days) were analysed. More than half of the chronic drug therapy of patients was not mentioned on the transfer notes (61.3% omitted drugs). For the 275 other drugs prescribed on the transfer notes, 129 medication discrepancies were identified (39 concerning chronic medication, 90 concerning ICU drugs). In comparison with the drug history, altered active substance or posology occurred most frequently (32/39, 82.1%). Concerning new drugs initiated in the ICU, the most common types of medication discrepancies were lack of information regarding indication for new drugs (14.4%), regarding intended duration of drug therapy (18.9%) and regarding suspended drugs (16.7%). Antisecretory drugs, insulin therapy and antimicrobial agents were most commonly involved. Of the prescribed ICU drugs at transfer,15% of intravenous drugs were eligible for intravenous to oral switch.

Conclusion ICU to ward transfer is associated with a great burden of medication discrepancies. Transfer notes specifying reasons for alterations of drug therapy could improve the quality of available drug information at hand-off.

References and/or Acknowledgements

1. Lee, et al. Ann Pharmacother 2010;44:1887-95

References and/or AcknowledgementsNo conflict of interest.