Short, A., McPeake, J. , Andonovic, M., McFee, S., Quasim, T. , Leyland, A. , Shaw, M., Iwashyna, T. and MacTavish, P. (2023) Medication-related problems in critical care survivors: a systematic review. European Journal of Hospital Pharmacy: Science and Practice, 30(5), pp. 250-256. (doi: 10.1136/ejhpharm-2023-003715) (PMID:37142386) (PMCID:PMC10447966)
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Abstract
Objectives: There are numerous, often single centre discussions of assorted medication-related problems after hospital discharge in patients who survive critical illness. However, there has been little synthesis of the incidence of medication-related problems, the classes of medications most often studied, the factors that are associated with greater patient risk of such problems or interventions that can prevent them. Methods: We undertook a systematic review to understand medication management and medication problems in critical care survivors in the hospital discharge period. We searched OVID Medline, Embase, PsychINFO, CINAHL and the Cochrane database (2001–2022). Two reviewers independently screened publications to identify studies that examined medication management at hospital discharge or thereafter in critical care survivors. We included randomised and non-randomised studies. We extracted data independently and in duplicate. Data extracted included medication type, medication-related problems and frequency of medication issues, alongside demographics such as study setting. Cohort study quality was assessed using the Newcastle Ottowa Score checklist. Data were analysed across medication categories. Results: The database search initially retrieved 1180 studies; following the removal of duplicates and studies which did not fit the inclusion criteria, 47 papers were included. The quality of studies included varied. The outcomes measured and the timepoints at which data were captured also varied, which impacted the quality of data synthesis. Across the studies included, we found that as many as 80% of critically ill patients experienced medication-related problems in the posthospital discharge period. These issues included inappropriate continuation of newly prescribed drugs such as antipsychotics, gastrointestinal prophylaxis and analgesic medications, as well as inappropriate discontinuation of chronic disease medications, such as secondary prevention cardiac drugs. Conclusions: Following critical illness, a high proportion of patients experience problems with their medications. These changes were present across multiple health systems. Further research is required to understand optimal medicine management across the full recovery trajectory of critical illness. PROSPERO registration number: CRD42021255975.
| Item Type: | Articles |
|---|---|
| Additional Information: | JM is funded by a The Healthcare Improvement Studies Institute (University of Cambridge) Fellowship PD-2019-02-16. AL is funded by the Medical Research Council (MC_UU_00022/2) and the Scottish Government Chief Scientist Office (SPHSU17). |
| Keywords: | Medication related problems, intensive care, ICU-follow-up and post intensive care syndrome. |
| Status: | Published |
| Refereed: | Yes |
| Glasgow Author(s) Enlighten ID: | Mactavish, Mrs Pamela and Quasim, Professor Tara and Andonovic, Dr Mark and Leyland, Professor Alastair and Shaw, Dr Martin and McPeake, Dr Jo |
| Authors: | Short, A., McPeake, J., Andonovic, M., McFee, S., Quasim, T., Leyland, A., Shaw, M., Iwashyna, T., and MacTavish, P. |
| College/School: | College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > MRC/CSO SPHSU College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing > Nursing and Health Care |
| Journal Name: | European Journal of Hospital Pharmacy: Science and Practice |
| Publisher: | BMJ Publishing Group |
| ISSN: | 2047-9956 |
| ISSN (Online): | 2047-9964 |
| Published Online: | 04 May 2023 |
| Copyright Holders: | Copyright © 2023 The Authors |
| First Published: | First published in European Journal of Hospital Pharmacy: Science and Practice 30(5):250-256 |
| Publisher Policy: | Reproduced under a Creative Commons License |
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