Medication reconciliation in intensive care units of a tertiary hospital in Saudi Arabia: An evaluation of medication discrepancies.

Background: Patients discharged from intensive care units (ICUs) are at higher risk for medication discrepancies, which can harm patients, increase healthcare costs, and lead to readmission. This study aimed to describe the frequency and types of medication discrepancies among ICU patients upon discharge and identify the factors associated with medication discrepancies.

Materials and methods: This retrospective cohort study included patients ≥ 18 years old, admitted to medical or surgical ICUs, and discharged on one or more medications. This study was done at a tertiary university hospital in Riyadh, Saudi Arabia. Data were collected through chart review over a 3-month period in 2018. Medication discrepancy was defined as any difference identified between the documented home medication list and the medication list on ICU discharge without any clearly documented justification. χ², Fisher exact test, and logistic regression were used to analyze the data.

Results: Out of 204 screened patients, 121 were included. The mean age was 51 ± 15.7 years, 57 (47.1%) were female, and 91 (75.2%) were admitted to the surgical ICU. The median ICU length of stay was 3 (2 - 7) days. In total, 216 medication discrepancies were identified; only 23 (19%) patients were discharged without any medication discrepancies. The mean medication discrepancies identified per patient were 2 ± 1. The most common type of medication discrepancies identified were no indication of therapy (43.8%), drug omissions (33.7%), and discrepancies in the duration of therapy (11.2%). Mechanically ventilated patients were less likely to have medication discrepancies upon discharge (OR = 0.24, 95% CI = (0.07 - 0.90)).

Conclusion: This study demonstrated many medication discrepancies among patients discharged from ICUs at KSUMC University Hospital in Riyadh, Saudi Arabia. The lack of a systematic approach to medication reconciliation might contribute to the increased number of medication discrepancies in comparison to multiple studies in different countries exploring the medication discrepancies among ICU patients. Establishing a process that includes pharmacist-driven medication reconciliation is needed.