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.