Snapshot audit of medicines reconciliation activities across two intensive care units

Background

Clinical pharmacy is an integral part of the critical care multi-disciplinary team (MDT), with documented evidence for improved patient outcomes. Medicines reconciliation (MR) is still a cornerstone of many clinical pharmacy teams, with the CQC recommending that this activity is completed when a patient is transferred from another setting.

During a recent departmental information gathering for an MR quality-improvement project, a subset analysis of the data specific to two intensive care units (ICU) was performed.

Objectives

To audit the ICU pharmacy teams’ medicine reconciliation events (MRE) assessing:

• How long the activity took
• Whether interventions were made during MRE
• Which ICU the patient was on
• Whether a Venous Thromboembolism (VTE) Risk Assessment was completed (standard 100% completed)
• Was the patients’ MRE within 24hrs of admission to the ICU (standard 95% completed within 24hrs of admission)
• Was a patient weight documented (standard 100% documented on patient electronic prescription and medicines administration [EPMA] system).

Method

A Microsoft Form was developed and completed by the members of the pharmacy team after each MRE, over a working week in April 2024. Data was analysed using Microsoft Excel. Results were presented to the ICU pharmacy team and wider ICU MDT during a clinical governance meeting.

Results

There were 11 documented MREs which occurred during the week:

• 91% (n=10) MREs completed in <15minutes; one took between 16-30minutes.
• 45% (n=5) MREs resulted in pharmacist prescriber interventions.
• 73% (n=8) admissions were on the General ICU; 27% (n=3) on Neuro ICU.
• 91% (n=10) patients had a completed VTE Risk Assessment (standard not met).
• 82% (n=9) patients had MRE within 24hrs of admission to the ICUs (standard not met).
• 9% (n=1) had their weight documented on EPMA; 9% (n=1) had no weight documented; 82% (n=9) had a weight on the ICU electronic patient record (EPR) system (standard not met).

Conclusion

The audit revealed that standards were not met. The admission checklist has been amended on the ICU EPR, to emphasise the importance of VTE risk assessment and weight being documented. The two patients with delayed MRE by the pharmacy team were admitted over the weekend. Currently, a five-day service is available; this data supports scoping a business case to increase to a seven-day service, as suggested in the Guidelines for the Provision of Intensive Care Services (GPICS).

Limitations of data were that it failed to take into account any patients who died, or were discharged or transferred before the ICU pharmacy team reviewed them, and that the types of interventions made were not recorded on the audit form.

This baseline data will form the basis for a more in-depth medicines reconciliation and intervention audit of the clinical pharmacy team on the critical care units, due to take place during Summer 2024.

This study did not require ethical approval.

The opinions expressed in this article are those of the author. They do not purport to reflect the opinions or views of the UKCPA or its members. We encourage readers to follow links and references to primary research papers and guidance.