Bosma Bertha Elizabeth, Meuwese Edmé, Tan Siok Swan, van Bommel Jasper, Melief Piet Herman Gerard Jan, Hunfeld Nicole Geertruida Maria, van den Bemt Patricia Maria Lucia Adriana
Department of Hospital Pharmacy, Haga Teaching Hospital, Els Borst-Eilersplein 275, 2545 CH, The Hague, The Netherlands.
Apotheek Haagse Ziekenhuizen (AHZ), Charlotte Jacobslaan 70, 2545 AB, The Hague, The Netherlands.
BMC Health Serv Res. 2017 Feb 10;17(1):124. doi: 10.1186/s12913-017-2065-y.
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.
重症监护病房（ICU）患者的转入和转出容易出现用药错误。本研究的目的是确定使用重症监护病房转运与用药核对（TIM）程序是否能减少ICU入院和出院时的用药错误数量以及相关的潜在危害和成本。
这项为期8个月的前瞻性观察研究采用前后对照设计，将评估TIM程序与荷兰两家医院常规护理相比的效果。如果患者在入院前至少使用一种药物且将在ICU至少停留24小时，则纳入研究。如果患者被转至另一家医院、在同一周末入院和出院或无法用荷兰语或英语交流，则排除在外。在TIM程序中，临床药剂师在患者入住ICU后24小时内核对其用药史，得出“最佳可能”用药史并提交给ICU医生。在ICU出院时，临床药剂师与ICU医生核对规定的ICU用药和用药史，得出ICU出院用药清单，并为普通病房医生提供用药处方建议。主要结局指标是入住ICU 24小时后和ICU出院24小时后出现一项或多项用药转运错误的患者比例。次要结局指标是发生潜在药物不良事件的患者比例、潜在药物不良事件的严重程度以及相关成本。对于主要结局，将计算相对风险和95%置信区间。
本研究的优势在于TIM程序的量身定制设计以及两家参与研究的医院。本研究也有一些局限性：由于该程序不在周末进行，可能存在选择偏倚；收集的是潜在而非实际的药物不良事件；最后研究期相对较短。尽管如此，本研究结果将为ICU一项关键的安全干预措施提供有价值的信息。
荷兰试验注册：NTR4159，2013年9月5日。
