Summary of study characteristics
| Study/Country | Study design/centres (number) | Intervention target | Participants Inclusion criteria Exclusion criteria | Participant numbers (control/before: intervention/after) | Intervention description, (components) and (timing) |
| Anstey et al
Australia54 | Before-after (B-A); prospective; multi (n=5) | De-escalation of inappropriate stress ulcer prophylaxis (SUP) | Adult intensive care unit (ICU) patients (medical, surgical, cardiothoracic) Inclusion: consecutive ICU patients admitted during the active study period Exclusion: patients <18 years of age | 842 (469: 373) | SUP de-escalation bundle (education of ICU medical staff; guidelines; pharmacist-led prescription discontinuation) (ICU stay) |
| Bosma et al
Netherlands13 | B-A; prospective; multi (n=2) | Medication errors (MEs) on ICU discharge | Adult ICU patients (medical, surgical, neurosurgery, cardiology) Inclusion: patients admitted on ≥1 regular medicine with ICU stay >24 hours. Discharge (disch) patients included if in admission (adm) study part, surviving ≥24 hours after ICU disch Exclusion: patients transferred to another hospital, adm and disch same weekend period, patients unable to understand Dutch or English | 380 (203: 177) | Medicines reconciliation (med rec) at care transitions (by ICU pharmacist; in patient rounds; combined with medication review (med rev) by pharmacist with ICU medical staff review to create ICU disch medication list. Medication advice included as supplement to the ward discharge letter. Discharge medication prepopulated on the ward electronic (e-) prescribing system) (ICU adm, ICU stay, ICU disch) |
| Buckley et al
USA55 | B-A; retrospective; single | De-escalation of inappropriate SUP | Adult ICU patients (≥18 years) Inclusion: all patients receiving acid suppressing therapy (AST) Exclusion: patients on treatment for gastrointestinal (GI) disorders or admitted on AST. Patients in the emergency department, rehabilitation or psychiatric wards | 341 (174: 167) | SUP de-escalation programme (pharmacist-led authorised stress ulceration prescription management) (ICU stay, ward stay) |
| Coon et al
USA56 | B-A; prospective; single | Med rec (of specific intravenous vasoactives) | Adult ICU patients (neurosciences) Inclusion: all consecutive ICU patients transferred to the ward | 261 (130: 131) | Structured ICU handover checklist (incorporated into e-discharge documentation (by ICU medical staff)) (ICU disch) |
| D'Angelo et al
USA57 | B-A; retrospective; single | De-escalation of inappropriate antipsychotics | Adult ICU patients (medical) Inclusion: all ICU patients initiated on antipsychotic therapy for ICU delirium ≥24 hours prior to ward transfer | 281 (140: 141) | Antipsychotic discontinuation bundle (education of medical, nursing and pharmacy staff; clinical guidelines (including non-pharmacological interventions and de-escalation based on delirium screening) (ICU stay) |
| Hammond et al
USA58 | B-A; retrospective; single | De-escalation of inappropriate SUP | Adult ICU patients (medical) ≥18 years Inclusion: all patients prescribed AST Exclusion: diagnosis of GI bleed, receiving AST on ICU adm, or history of Zöllinger-Ellison syndrome | 219 (101: 118) | Educational interventions for SUP (education of ICU medical staff; guideline; pharmacist on ward rounds to support education) (ICU stay) |
| (B) Wohlt et al
62
(A) Hatch et al 59 USA | B-A; retrospective; single | De-escalation of inappropriate SUP | Adult ICU patients (medical, surgical) ≥18 years Inclusion: all ICU patients Exclusion: patients with a GI bleed, Zöllinger-Ellison syndrome, prisoner status or died in hospital | 750 (394: 356) | Education on SUP (education of ICU and ward medical and pharmacy staff; audit and feedback of preintervention results; guideline) (ICU stay, ward stay) |
| Heselmans et al
Belgium14 | Randomised controlled trial; prospective; multi (n=3) | Drug-related problems in patients after ICU to ward transfer | ICU patients (medical, surgical) ≥15 years Inclusion: patients with ICU stay ≥3 days and transferred to surgical, medical or geriatric ward Exclusion: patients with a ‘do not resuscitate’ order | 600 (299: 301) | Medication review by ward-based pharmacists after ICU patient transfer (ward stay (<48 hours of ICU transfer)) |
| Kram et al
USA60 | B-A; retrospective; single | De-escalation of inappropriate antipsychotics | Adult ICU patients (medical, surgical, cardiothoracics, neurosciences and cardiac) ≥18 years Inclusion: ICU patients with atypical antipsychotic prescribed in ICU Exclusion: patients had <2 antipsychotic doses in ICU, on antipsychotics pre-ICU adm or non-delirium psychiatric indication, or if died in ICU | 358 (133: 225) | E-handover tool (prompting medication review by pharmacists (ICU and ward); supported by education (pharmacy staff), including audit and feedback of preintervention results) (ICU stay; ICU disch; ward stay) |
| Medlock et al Netherlands61 | B-A; prospective; single | ICU e-disch letter (template included med rec details) | Adult ICU patients (medical, surgical) Inclusion: all critical care patients (discharged alive or dead) | 6823 (1872: 4951) | E-letter to ward medical staff and general practitioner (with template and automatic assignment to ICU medical staff) (ICU disch) |
| Meena et al
USA47 | B-A; retrospective; single | De-escalation of inappropriate SUP | Adult ICU patients Inclusion: all ICU patients Exclusion: patients already taking AST on admission, therapeutic indication for AST, patients died within 24 hours of admission | 224 (106: 118) | Education sessions for medical staff (didactic education session for junior medical staff) (ICU stay) |
| Parsons Leigh et al
Canada48 | B-A; retrospective; single | ICU e-transfer tool with eight key elements (including active medicines and med rec) | Adult ICU patients (medical, surgical, neurosurgical and trauma) Inclusion: randomly selected cohort of ICU patients transferred to an inpatient ward Exclusion: ICU patients not transferred to an inpatient ward | 60 (30: 30) | E-transfer tool (auto-population of elements, eg, medicines to continue on ward transfer with facility to review and refine; facility to compare with preadmission med rec and identify changes (by medical staff)) (ICU disch) |
| Pavlov et al
USA49 | B-A; retrospective; single | De-escalation of inappropriate SUP and bronchodilators | Adult ICU patients (medical, surgical) Inclusion: ICU patients on acid blockers or bronchodilators Exclusion: patients who died during their adm or still in ICU on study data extraction | 454 (201: 253) | Med rec (on hospital adm (pharmacy technician) and ICU disch (ICU nurse), with medical staff confirmation and in reconciliation with medication on ICU disch) (ICU disch) |
| Pronovost et al
USA50 | Time-series analysis; prospective; single | MEs on ICU discharge | Adult ICU patients (surgical) Inclusion: random selection of 10–15 patients per week | No information | Med rec (by ICU nurses on patient adm and ICU disch. Specific MEs prompted discussion with ICU medical staff) (ICU adm, ICU disch) |
| Stuart et al
USA53 | B-A; retrospective; single | De-escalation of inappropriate antipsychotics | Adult ICU patients (medical, surgical, cardiac) Inclusion: ICU patients with antipsychotic prescribed for delirium Exclusion: palliative care or died, on antipsychotics pre-ICU adm, or non-delirium psychiatric indication | 158 (79: 79) | Pharmacist-led de-escalation protocol (de-escalation guideline with education of staff (ICU and ward pharmacists). Pharmacists authorised to discontinue or taper antipsychotics in ICU patients with resolved delirium symptoms) (ICU stay (direct patient disch), ward stay) |
| Tasaka et al
USA51 | B-A; retrospective; single | De-escalation of inappropriate SUP | Adult ICU patients (medical, surgical) Inclusion: all ICU patients Exclusion: patients requiring continued AST (eg, active GI bleed), or no indication for AST (eg, total gastrectomy) | 124 (74: 50) | SUP de-escalation bundle. Guideline, education of staff (medical, nurses, pharmacists, dietitians), multifaceted awareness campaign, pharmacist SUP recommendations (on care rounds, or by text/telephone) with documentation in e-medical notes. SUP not included in the e-prescribing core or ICU adm order sets (ICU stay) |
| Zeigler et al
USA52 | B-A; retrospective; single | De-escalation of inappropriate SUP | Adult ICU patients (medical, surgical) Inclusion: all ICU patients in study period Exclusion: patients receiving AST pre-ICU adm, or acute GI bleed indication, or if they died | 114 (53: 61) | Med rec (by nurses and pharmacist with medical staff review. At care transitions and hospital disch. Training via classes, web-based module, hospital presentations and individual sessions. No SUP education given) (ICU adm, ICU disch, hospital disch) |