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Dropping the Ball: Post ICU, Many Patients Not Getting the Correct Meds - Michigan Medicine

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In the intensive care units of hospitals everywhere, patients fight for their lives against serious disease while teams of clinicians work around the clock, doing whatever it takes to stabilize them. But what happens to these patients once they leave this high stakes environment?

For many, the intense juggling act of the ICU gives way to “a series of dropped balls”, says Theodore J. Iwashyna, M.D., Ph.D., professor of critical care medicine at the University of Michigan and a staff physician at the VA Ann Arbor. He, along with collaborators Antoinette Coe, PharmD, Ph.D. of the U-M College of Pharmacy and Brenda Vincent of the Center for Clinical Management Research with the U.S. Department of Veterans Affairs, reveal important lapses in medication reconciliation, the rate at which patients resume taking necessary medications and stop taking unnecessary ones prescribed during their hospitalization.

Using a data set of more than a million patients from the VA health system who were discharged after a hospitalization, they examined prescription fill rates for two important drugs: statins, heart drugs that are often stopped by care teams during hospitalization; and antipsychotics, which are commonly prescribed for hospital-induced delirium. This is the first time this has been done in a national hospital system.

They found wide variances between hospitals in the rate at which patients filled these prescriptions within six months after discharge. Statin discontinuation ranged from 10 to 15% and new antipsychotic prescription fills from 2 to 4%.

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High risk patients who were in the ICU or who were diagnosed with sepsis, a potentially life threatening infection, had the highest rates of statin discontinuation and antipsychotic continuation. Iwashyna notes “the leading cause of sepsis in 2020 is COVID-19.”

“The VA has some of the country’s best medical reconciliation data,” Iwashyna says. “I think the problem is smaller in the VA than in the rest of the healthcare system because the VA has the systems to let you actually see it and has been trying to fix it. When other individual hospitals have studied parts of this problem, often they are worse.”

He notes that there is no requirement to document why drugs are discontinued in the ICU, but there are likely few legitimate reasons for the changes in medication use to continue long after hospitalization.

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