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

Abstract

Background: 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.

Methods: 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.

Discussion: 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.

Trial registration: Dutch trial register: NTR4159 , 5 September 2013.

Keywords: Adverse drug event; Clinical pharmacist; Intensive care unit; Medication error; Medication reconciliation; Medication transfer.

Fig. 1

Study flow chart of the TIM program and defined outcomes. ICU = intensive care unit, MTE = medication transfer error, pADE = potential adverse drug event, TIM = Transfer ICU and Medication reconciliation program

Fig. 2

Example of BPMDL-ICU. BPMDL-ICU = best possible ICU medication discharge list. N.B. This is a fictitious example, patient and doctor names are imaginary

Fig. 3

Study procedure pre- and post-intervention. BPMDL-ICU = best possible ICU medication discharge list, BPMH = best possible medication history, BPML-GW24 = best possible general ward medication list 24 h after ICU discharge, CPOE/CDS system = computerized physician order entry systems with clinical decision support, ER = emergency room, HIS = hospital information system, ICU = intensive care unit, OR = operating room, PDMS = patient data monitoring system, TIM = Transfer ICU and Medication reconciliation program

Fig. 4

Flow chart. Assessment of unintended medication discrepancies. BPMH = best possible medication history, ICU = intensive care unit, MTE = medication transfer error, PDMS = patient data monitoring system