The effect of the TIM program (Transfer ICU Medication reconciliation) on medication transfer errors in two Dutch intensive care units: design of a prospective 8-month observational study with a before and after period.
The transfer of patients to and from the Intensive Care Unit (ICU) is prone to medication errors. The aim of the present study is to determine whether the number of medication errors at ICU admission and discharge and the associated potential harm and costs are reduced by using the Transfer ICU and Medication reconciliation (TIM) program.



This prospective 8-month observational study with a pre- and post-design will assess the effects of the TIM program compared with usual care in two Dutch hospitals. Patients will be included if they are using at least one drug before hospital admission and will stay in the ICU for at least 24 h. They are excluded if they are transferred to another hospital, admitted and discharged in the same weekend or unable to communicate in Dutch or English. In the TIM program, a clinical pharmacist reconciles patient's medication history within 24 h after ICU admission, resulting in a "best possible" medication history and presents it to the ICU doctor. At ICU discharge the clinical pharmacist reconciles the prescribed ICU medication and the medication history with the ICU doctor, resulting in an ICU discharge medication list with medication prescription recommendations for the general ward doctor. Primary outcome measures are the proportions of patients with one or more medication transfer errors 24 h after ICU admission and 24 h after ICU discharge. Secondary outcome measures are the proportion of patients with potential adverse drug events, the severity of potential adverse drug events and the associated costs. For the primary outcome relative risks and 95% confidence intervals will be calculated.



Strengths of this study are the tailor-made design of the TIM program and two participating hospitals. This study also has some limitations: A potential selection bias since this program is not performed during the weekends, collecting of potential rather than actual adverse drug events and finally a relatively short study period. Nevertheless, the findings of this study will provide valuable information on a crucial safety intervention in the ICU.



Dutch trial register: NTR4159 , 5 September 2013.
Department of Hospital Pharmacy, Haga Teaching Hospital, Els Borst-Eilersplein 275, 2545 CH, The Hague, The Netherlands. b.e.bosma@erasmusmc.nl.|Apotheek Haagse Ziekenhuizen (AHZ), Charlotte Jacobslaan 70, 2545 AB, The Hague, The Netherlands. b.e.bosma@erasmusmc.nl.|Department of Hospital Pharmacy, Erasmus University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands. b.e.bosma@erasmusmc.nl.
Bertha Elizabeth
BE
Bosma
Department of Hospital Pharmacy, Erasmus University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands.
Edmé
E
Meuwese
Institute for Medical Technology Assessment, Erasmus University Rotterdam, PO Box 1738, 3000, DR, Rotterdam, The Netherlands.
Siok Swan
SS
Tan
Intensive Care Unit, Erasmus University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands.
Jasper
J
van Bommel
Intensive Care Unit, Haga Teaching Hospital, Leyweg 275, 2545 CH, The Hague, The Netherlands.
Piet Herman Gerard Jan
PH
Melief
Intensive Care Unit, Erasmus University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands.
Nicole Geertruida Maria
NG
Hunfeld
Department of Hospital Pharmacy, Erasmus University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands.
Patricia Maria Lucia Adriana
PM
van den Bemt
D003422:Critical Care / Q000592:standards*; D011307:Drug Prescriptions / Q000592:standards; D064420:Drug-Related Side Effects and Adverse Reactions / Q000453:epidemiology; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008508:Medication Errors / Q000706:statistics & numerical data*; D059065:Medication Reconciliation / Q000379:methods*; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D010351:Patient Discharge / Q000592:standards*; D010595:Pharmacists / Q000592:standards; D011446:Prospective Studies; D015983:Selection Bias
Adverse drug event; Clinical pharmacist; Intensive care unit; Medication error; Medication reconciliation; Medication transfer