Failure to reintroduce home medication in critically ill patients

Abstract

Purpose

Home medication is often discontinued or adjusted during hospital admission. This study aims to investigate discrepancies between home medication before admission and at ICU discharge.

Materials and methods

In this retrospective cohort study, electronic health records of 200 patients admitted to the ICU of a large teaching hospital in the Netherlands between August 1, 2021, and September 30, 2022, were analyzed for (dis) continuation of home medication. Inclusion criteria: first-time ICU admission during hospital stay, a length of stay ≥48 h, survival at ICU discharge, and use of home medication at hospital admission. Exclusion criteria: transfer from/to another hospital, discharge with palliative care, or chronic ventilation with an elective admission.

Results

The mean patient age was 63.5 (±12.8) years, and 63.0 % were male. Most ICU admissions were non-surgical (76.0 %). Mean APACHE4 scores were 68.4 (±22.9). At ICU discharge, 46.7 % (535/1003) of home medications were not reintroduced, with 22.4 % incorrectly not reintroduced, while at hospital discharge, these rates were 12.1 % (106/876) and 14.2 %, respectively.

Conclusions

Nearly half of home medications were discontinued at ICU discharge, with nearly a quarter not properly reintroduced on ward transfer, posing unnecessary risks. However, at hospital discharge, most home medications were correctly reintroduced or appropriately discontinued.