An evaluation of standardised pharmaceutical handover on critical care units
Authors: Thomson J 
Published: November 2022

Abstract

Introduction
Patients cared for in the Critical Care unit are severely ill and may require multiple changes to their usual medication and new medicines to manage their current clinical condition. Due to pharmacist working patterns at University Hospital Southampton (UHS) patients on the Critical Care unit will receive pharmaceutical care from more than one pharmacist. It is vital that any changes are communicated between members of the pharmacy team as deliberate clinical decisions and not accidental omissions or errors. It is recognised that transfer of patients between professionals or teams caring for them is “one of the very high-risk transactions of health care service” 1. Errors of omission in medication for chronic conditions on Critical Care may lead to continuing omission of this therapy following discharge from hospital.2

Aim
To assess the impact on pharmacist time and patient care of a formalised pharmaceutical handover for Critical Care patients at UHS.

Methods
Handovers are part of routine pharmaceutical care and ethics approval was not required. A pharmacist handover tool was developed within the existing Microsoft Access database used on Critical Care at UHS. Prior to the implementation a cohort of patients were identified and followed up on Critical Care discharge. Data were collected regarding pharmacist documented pre-Critical care medication, changes to this medication, ITU prophylaxis therapies. Following implementation, a second cohort was identified and a further data set collected. Data was analysed using a series of chi-squared tests and two-sample t-tests. Qualitative data were collected about ward pharmacist perceptions of pharmaceutical handover issues from Critical Care and regarding the Critical Care pharmacists’ use of the system and perceptions following its introduction. Ethical approval was not required for this service development initiative and evaluation.

Results
Favourable trends were detected following the introduction of the standardised handover tool: these did not reach statistical significance in most of the outcomes measured. There wasa statistical difference in the number of changes to pre-ITU medication detected following the handover introduction (p=0.028). The ward pharmacists consulted often had queries about medication changes. Within the critical care team the system was regarded as easy to use and useful.

Discussion/Conclusion
The standardised handover was well received by the Critical Care team who considered it to be simple to use and a useful tool. Statistical significance was not reached for the majority of measures although a positive trend was detected, probably due to the small sample size. Further standardisation handover system will ensure consistency of pharmaceutical care for this group of complex patients. Since this project was completed, the tool developed has been incorporated into the clinical information system now used within the Trust and has been developed further as an integrated part of the system. The tool is also used within other areas who use the clinical information system and will be reviewed and developed for their specialist areas including neonatal and paediatric intensive care where the information hand over may require different priority areas to be highlighted. Ward pharmacists are also able to access the clinical information handover tool and has led to a reduction in post-critical care queries.

References
1. Royal College of Physicians. Handover documents: headings and definition. Available from: www.rcplondon.ac.uk. Accessed 8 December 2009
2. Bell CM, Brener SS, Gunraj NG, Huo C, Bierman AS, Scales DC et al. Association of ICU or hospital admission with unintentional discontinuation of medications for chronic disease. JAMA. 2011;306(8):840-847