Inappropriate discharge on bronchodilators and acid-blocking medications after ICU admission: importance of medication reconciliation.
BACKGROUND
Previous studies suggest that some medications, including proton pump inhibitors and β-agonist inhalers, are administered to hospitalized patients and sometimes continued without indications. Medication reconciliation has been offered as one mechanism to reduce the frequency of such medication errors and is now mandated by the Joint Commission (NPSG.03.06.01). We hypothesized that (1) β agonists and acid-blocking medications are prescribed following critical illness without indications, and (2) medication reconciliation can reduce the frequency of inappropriate continuation of these agents. The study was carried out in a 414-bed community teaching hospital affiliated with the University of Connecticut Medical School. All subjects were admitted to the ICU between February and April 2012 (physician-driven reconciliation) and between July and September 2012, just following implementation of pharmacy technician-driven medication reconciliation. This was a retrospective cohort study.


METHODS
Medical records of all subjects were reviewed using a uniform data extraction tool. Demographic information, clinical data, in-patient and out-patient medications (before and following hospital discharge), and outcomes were recorded.


RESULTS
Prior to pharmacy technician-administered, physician-confirmed medication reconciliation, 253 ICU subjects were compared to 291 subjects admitted to the ICU after initiation of this process. There were no differences in admission type, stay, history of coronary artery disease, requirements for mechanical ventilation, or length of mechanical ventilation between groups. Rates of discharge on bronchodilators (8.9 vs. 4.2%, P = .09) or acid blockers (19.1 vs. 11.2%, P = .05) without clinical indications were lower with pharmacy technician-driven, physician-confirmed medication reconciliation than with routine physician-driven medication reconciliation. Multiple logistic regression analyses demonstrated a significant association of mechanical ventilation with inappropriate discharge on both bronchodilators and acid blockers. Pharmacy technician-driven medication reconciliation tended to reduce these errors.


CONCLUSIONS
In our hospital, acid blockers and bronchodilators were often continued inappropriately following critical illness. The specific pharmacy technician-driven method of medication reconciliation deployed in our hospital reduced by half but did not eliminate this medication error.
Department of Internal Medicine, Hospital of Central Connecticut, New Britain, Connecticut, and University of Connecticut School of Medicine, Farmington, Connecticut.
Andrey
A
Pavlov
Department of Internal Medicine, Hospital of Central Connecticut, New Britain, Connecticut, and University of Connecticut School of Medicine, Farmington, Connecticut.
Rostislav
R
Muravyev
Bridgeport Hospital, Bridgeport, Connecticut, and Yale University School of Medicine, New Haven, Connecticut.
Yaw
Y
Amoateng-Adjepong
Department of Internal Medicine, Hospital of Central Connecticut, New Britain, Connecticut, and University of Connecticut School of Medicine, Farmington, Connecticut. constantinemanthous@gmail.com.
Constantine A
CA
Manthous
D000318:Adrenergic beta-Agonists / Q000627:therapeutic use*; D001993:Bronchodilator Agents / Q000627:therapeutic use*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D057970:Inappropriate Prescribing; D007362:Intensive Care Units; D008297:Male; D059065:Medication Reconciliation; D008875:Middle Aged; D010351:Patient Discharge; D054328:Proton Pump Inhibitors / Q000627:therapeutic use*; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome
D000318:Adrenergic beta-Agonists; D001993:Bronchodilator Agents; D054328:Proton Pump Inhibitors
bronchodilator; histamine antagonist; mechanical ventilation; medication error; medication reconciliation; proton pump inhibitor