Table 4.
Medication transfer errors (MTE) and potential adverse drug event (pADE) outcomes
| MTE and pADE outcomes | Pre-intervention phase | Post-intervention phase | ORaadj [CI 95%] |
|---|---|---|---|
| Patients = 264 | Patients = 212 | ||
| ICU admission | |||
| Patients with ≥ 1 MTE (n, %) | 119 (45.1%) | 31 (14.6%) | 0.18 [0.11–0.30] |
| Patients with ≥ 0.01 pADE (n, %) | 92 (34.8%) | 17 (8.0%) | 0.13 [0.07–0.24] |
| Without harm (pADE = 0) | 27 (22.7%) | 14 (45.2%) | |
| Very low harm expected (0.01 ≤ pADE > 0.1) | 35 (29.4%) | 6 (19.4%) | |
| Low harm expected (0.1 ≤ pADE > 0.4) | 45 (37.8%) | 7 (22.6%) | |
| Medium harm expected (0.4 ≤ pADE > 0.6) | 7 (5.9%) | 3 (9.7%) | |
| High harm expected (pADE ≥ 0.6) | 5 (4.1%) | 1 (3.2%) | |
| MTE (n, per patient) | 206 (0.78) | 39 (0.18) | |
| pADE (n, per patient) | 12.58 (0.05) | 2.77 (0.01) | |
| Medications with MTE (% of all medications) | 12.3% | 2.9% | |
| Medications with ≥ 0.01 pADE (n, % of all medications) | 146 (8.7%) | 20 (1.5%) | |
| Total prevented MTEb (n, per patient) | 126.4 (0.60) | ||
| Total prevented pADEc (n, per patient) | 7.33 (0.03) | ||
| Patients = 203 | Patients = 177 | ||
|---|---|---|---|
| ICU discharge | |||
| Patients with ≥ 1 MTE (n, %) | 150 (73.9%) | 73 (41.2%) | 0.24 [0.15–0.37] |
| Patients with ≥ 0.01 pADE (n, %) | 141 (69.5%) | 64 (36.2%) | 0.26 [0.17–0.40] |
| Without harm (pADE = 0) | 9 (6.0%) | 9 (12.3%) | |
| Very low harm expected (0.01 ≤ pADE > 0.1) | 33 (22.0%) | 28 (38.4%) | |
| Low harm expected (0.1 ≤ pADE > 0.4) | 56 (37.3%) | 25 (34.3%) | |
| Medium harm expected (0.4 ≤ pADE > 0.6) | 33 (21.9%) | 6 (8.2%) | |
| High harm expected (pADE ≥ 0.6) | 19 (12.7%) | 5 (7%) | |
| MTE (n, per patient) | 399 (1.97) | 122 (0.69) | |
| pADE (n, per patient) | 41.97 (0.21) | 9.55 (0.05) | |
| Medications with MTE (% of all medications) | 17.9% | 6.4% | |
| Medications with ≥ 0.01 pADE (n, % of all medications) | 14.9% (333) | 5.4% (102) | |
| Total prevented MTEb (n, per patient) | 225.9 (1.28) | ||
| Total prevented pADEc (n, per patient) | 26.59 (0.15) | ||
MTE medication transfer error, pADE potential adverse drug event
aAdjusted for APACHE IV
bAverage MTE per patient at intervention subtracted by score pre-intervention and multiplied with number of patients at intervention
cAverage pADE score per patient at the intervention subtracted by score pre-intervention and multiplied with number of patients at intervention