Prevent Med Errors at ICU Transitions of Care

Almost half of patients experience a med error when transferring from the ICU to a non-ICU setting.

Incorporate these strategies to reduce the risk of error.

Stop unnecessary meds. When transferring patients, switch ICU-specific protocols to floor protocols...such as electrolyte replacement.

Remove pressors and other ICU drips from your patient's med list...and PRN opioids, sedatives, or neuromuscular blockers left over from mechanical ventilation.

If your EHR allows, sort transfer meds by "order set" to quickly identify meds from ICU sets.

Discontinue PRN antipsychotics used acutely for ICU delirium. One in four patients has an antipsychotic mistakenly continued when transferred out of the ICU...and a third of these continue after discharge.

Stop stress ulcer prophylaxis started for severely ill ICU patients. It's not indicated when these patients transfer to the floor.

Also reassess VTE prophylaxis. It may need to be stopped in ambulating patients...or added in those with resolving bleeding risks.

Also ask IT to remove "continue all" buttons from transfer orders.

Restart necessary meds. Perform med rec before ICU transfer, even if it was already done at admission. About 75% of home meds are stopped on ICU admission. Readdressing may help catch omitted meds.

For example, antiplatelets may be held while ruling out a bleed...or some home oral meds may be held in an NPO patient.

On the other hand, document if a med is intentionally stopped or it's not accidentally restarted at discharge.

Double-check dosing. We know to renally adjust meds. But ensure there's a process to communicate these adjustments at transfer...and to readjust meds as renal function changes.

Ensure doses for IV to PO switches are correct. For example, oral levothyroxine should be about twice the IV dose.

See our Transitions of Care Checklist for more strategies to improve care.

Key References

  • Crit Care Med 2019;47(4):543-9
  • Ann Intensive Care 2018;8(1):19
  • J Clin Pharm Ther 2015;40(5):578-83
Hospital Prescriber's Letter. May 2019, No. 350522

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