Preventing medication errors in the ICU: Four key pillars to safer patients

New light in the fight against medication errors in the ICU setting

Hospital pharmacists are uniquely positioned to support risk reduction in medication errors in the ICU. A 2023 study by the Special Interest Group (SIG) for the Investigation of Medication Errors in ICUs & EAHP European Statements of Hospital Pharmacy explored the prevalence of medication errors, identified contributing factors, and illuminated prevention strategies for improving medication safety in the ICU.

We’ve distilled these findings into four key pillars of opportunity and recommendations for application in the ICU setting.  

1. Leveraging clinical technology 

Pharmacy leaders should make technology a key consideration in reducing medication errors in the ICU—prioritizing integration of existing and future systems. The SIG study found that 47% of respondents had not fully implemented computerized prescriber order entry (CPOE) in the ICU.

Pharmacy leaders should prioritize opportunities to create “closed-loop” electronic medication management systems (EMMSs). These systems have been examined in US and Finnish hospitals in the International Journal of Environmental Research and Public Health and been found to decrease or eliminate many historic medication management problems.

Leadership should be prepared to provide dedicated resources for this initiative, facilitating implementation, optimization, and maintenance, including regular updates to all involved systems around ICU medication management. These opportunities will include fundamental steps like replacing paper-based prescriptions, swapping them out for electronic prescribing (e-prescribing) systems, and integrating them with clinical decision support built for the ICU setting. 

2. Improving clinician access to appropriate medications and resources

Clinicians need seamless access to medication information to answer clinical questions— value that is highlighted in the World Health Organization’s (WHO) Strategic Framework of the Global Patient Safety Challenge.

Pharmacy leaders should look for opportunities to ensure their ICU clinicians have easy and immediate access (on both mobile and desktop) to all appropriate antidotes, reversal agents, rescue agents, and relevant protocols. This access is reliant on the maintenance of a comprehensive suite of updated reference sources and guidelines. These sources should be approved at the organizational level and then made available digitally. Robust governance and version control measures should also be in place to maintain quality patient safety outcomes. 

3. Aligning organizational safety culture and working environment

Achieving results in medication error reduction is more than an exercise in tactics and tools. It has to start at the organizational level—creating a culture of safety that is reflected in the ICU environment. Clinicians will need a system to support reporting of medication-related incidents and near misses, including mechanisms to facilitate feedback conversations with ICU staff, such as “hot debriefs” after critical or potentially traumatic events in the ICU. Personnel should also be a consideration—the SIG study found that 79% of respondents didn´t have a clinical pharmacist allocated in the ICU.

A 2021 study out of Japan revealed that incident reporting, a cornerstone of safety culture in hospitals, was lagging. While 78% of physicians-in-training had attended patient safety lectures, 44% had not submitted an incident report in the previous year, and over 40% did not know how to submit an incident report. A separate qualitative study out of Japan found that formal meetings are an area of opportunity to address root causes and corrective measures. The SIG study found that 45% of respondents had not fully implemented an incident reporting system.

4. Focusing on IV medication

The increased use of IV medications provides an area of opportunity in reducing medication errors, but safety persists as a leading challenge. The SIG ICU study suggests providing supporting protocols and guidelines on IV medication preparation appropriate to the setting and availability of “ready-to-administer” infusion solutions.

A study on nursing errors during IV infusion in Mosul, Iraq, found notable defects during the infusion process. Recommendations included training courses as well as alerting nurses to follow proper procedures and universal standard protocols.

Pharmacy leaders are facing ever-increasing challenges in reducing medication errors and supporting clinicians in the ICU setting, but advanced medication decision support solutions are available to keep up with the evolving needs of patients and institutions.

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