Intensive care patients surviving to transfer to a lower-acuity hospital ward experience ongoing challenges to their recovery and lack a well-defined and developed care pathway. The transfer process to a hospital ward exposes intensive care patients to high-rates of medication errors, that increase their risk of adverse drug events. The aims of this study were to identify priorities for medication-related intervention components and outcome measures, for improving medication safety for intensive care patients transferring to a hospital ward.
Three panels involving 129 participants covering (i) intensive care and, (ii) hospital-ward healthcare professionals and, (iii) public representatives completed an electronic Delphi survey conducted over three phases. The Delphi process comprised of three sections (medication-related intervention components, medication outcomes and patient outcomes). Items were graded in their level of importance, with predefined important criteria. Item agreement required consensus across all three panels. Intervention barriers and facilitators identified in participant comments were categorised according to a socio-technical systems approach to the patient journey and patient safety (Systems Engineering Initiative for Patient Safety 3.0 model).
One-hundred and nine of the 129 (84.5%) of participants completed all three Delphi phases. Consensus was achieved for 48 intervention components, 13 medication outcome measures and 11 patient outcome measures. Phase One provided 158 comments comprising of more than 200 individual barriers and facilitators to intervention delivery. Frequently cited facilitators included: Clearly specified roles and responsibilities (10.7% (Organisational conditions)), Patient and family as agents (8.8% (Care Team)), Medicines-related information easily accessible (7.8% (Tools and Technologies), and Clear medication plan and communication (7.3% (Tasks)).
Our findings provide identification of priorities for medication-related intervention components to improve medication safety for intensive care patients transferring to a hospital ward. Prioritisation is complemented by the identification and socio-technical categorisation of barriers and facilitators to intervention delivery. The identified important medication and patient outcomes to measure will inform the design of a future patient medication safety intervention study.