Abstract

Objective: This study aimed to evaluate the influence of medication discrepancies (MDs) at intensive care unit (ICU) discharge on some key short-term post-ICU outcomes.
Methods: A retrospective cohort study was conducted using real-world ICU data, i.e., demographics, comorbidities, mechanical ventilation status, pre-admission medications, sources of medication history, discrepancies at admission and discharge, and risk factors such as polypharmacy and emergency admission. The MDs were classified into no indication for therapy, drug omission, therapeutic duplication, incorrect dose, inappropriate route, and inappropriate duration.
Results: MDs were identified in many patients, with drug omission and no indication for therapy being the most frequent. Patients with ≥ 2 discrepancies at ICU discharge had significantly longer post-ICU hospital stays than those without discrepancies (mean difference: +2.8 days; p < 0.01). High-risk discrepancy patterns, such as drug omission and incorrect dosing, were independently associated with early clinical deterioration within 72 hours of ICU transfer (adjusted OR: 2.31; 95% CI: 1.14–4.49). These negative effects were exacerbated by polypharmacy.
Conclusion: MDs at ICU discharge were significant determinants of early post-ICU clinical trajectories, which resulted in longer hospital stays and higher rates of early deterioration. Thus, strengthening of pharmacist-led medication reconciliation at critical transition points might mitigate preventable adverse outcomes and improve continuity of care for critically ill patients.

Key words: Medication discrepancies, ICU care, transitions, consequences, Saudi Arabia.