Management of long-term hypothyroidism: Aapotential marker of quality of medicines reconciliation in the intensive care unit

Barrett, N.A., Jones, A., Whiteley, C., Yassin, S. and McKenzie, C.A. (2012) Management of long-term hypothyroidism: Aapotential marker of quality of medicines reconciliation in the intensive care unit. International Journal of Pharmacy Practice, 20 (5), 303-306-----------. (doi:10.1111/j.2042-7174.2012.00205.x).

Abstract

Objective
Significant errors can be made during medication prescribing, dispensing and administration. One source of error and potential for harm is unintentional omission. Medicines reconciliation seeks to reduce the impact of this between transfer of care. In long-term hypothyroidism, patients are dependent upon levothyroxine and there are few contraindications to its prescription. We considered levothyroxine prescription in long-term hypothyroidism as a marker of medicines reconciliation on admission and during stay in the intensive care unit (ICU).

Methods
A retrospective chart review was undertaken in a tertiary referral university ICU with all patients who were receiving long-term levothyroxine therapy identified. Notes were reviewed for the presence of thyroid-replacement prescription and for thyroid function tests, in addition to demographic, length of stay and mortality data.

Key findings
Thyroid-replacement therapy was not prescribed for more than 7 days in 23/133 (17.3%) patients and omitted entirely in three patients. A further 28/133 (21.1%) patients were intolerant of enteral feeding for more than 7 days and were thus unable to have oral levothyroxine administered. None of these patients received parenteral therapy. Thyroid function tests were performed in 104/133 (78.2%) patients.

Conclusions
Prescription of chronic therapy, in this case thyroid-replacement therapy, was inadequate. This highlights the need for a progressive medicines-reconciliation process embedded within the daily ICU programme.

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Contributors

Author: C.A. McKenzie

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