4CPS-102 Assessing the impact of specialist pharmacist review on the safety of medications in patients recently discharged from intensive care

<h3>Background and Importance</h3> Medication review, with input from pharmacy, is a national standard for post intensive care (ICU) follow-up (GPICS, 2022). Despite this, few ICU pharmacy teams provide input at transfer of care. This study evaluated the impact of a specialist pharmacist review on medication safety for this patient group. <h3>Aim and Objectives</h3> To explore the number, and quality of interventions made by specialist ICU pharmacists following targeted review post ICU discharge. <h3>Material and Methods</h3> This was a prospective, multi-centre, cross-sectional, point prevalence study. Hospitals across southwest England were invited to participate. Patients were eligible for review if discharged from ICU to a ward during a five-day study period in June 2023. Reviews were conducted in person or remotely. Data were collected using an anonymised electronic form during the review. Data included type and frequency of intervention. The Harm Associated with Medication Error Classification tool was used to categorise interventions by the levels of potential harm, this was completed by an independent pharmacist at the base site. Results were analysed using descriptive statistics. <h3>Results</h3> Overall,134 patients were reviewed after discharge from ICU, of these 106 (79%) required a pharmacist intervention. Pharmacists made 344 interventions overall, with a mean 2.6 interventions per patient. Potential moderate harm was prevented by 8% (n=28) of the interventions, including stopping antibiotics which continued after planned course, errors in antihypertensive dosage, and not restarting regular medications. Potential serious harm was prevented by 2% (n=8) interventions; including incorrect doses of anticoagulants, inadvertent cessation of antimicrobials and absence of therapeutic drug monitoring in high-risk medications. <h3>Conclusion and Relevance</h3> Specialist Pharmacist review has the potential to reduce harm from medications in patients recently discharged from ICU. Medication errors at transfer were substantial, and more prevalent than in a large international study (Wang, 2022). This is the first UK study evaluating the impact of pharmacist intervention in this population. Further work should focus on the feasibility and cost-effectiveness of implementing this service. <h3>References and/or Acknowledgements</h3> McNaughton P, 2022. GPICS [On-line]. Faculty of Intensive Care Medicine. Available from: https://www.ficm.ac.uk/sites/ficm/files/documents/2022-07/GPICS%20V2.1%20%282%29.pdf Wang Y, <i>et al</i>. Evaluation of medication risk at the transition of care: a cross-sectional study of patients from the ICU to the non-ICU setting. <i>BMJ Open</i>, 2022 12. <h3>Conflict of Interest</h3> No conflict of interest