Designing a Medication Safety Programme for Intensive Care Units at Teaching Hospitals in South East Nigeria

Intensive care unit patients receive complex high-risk pharmacotherapy that predisposes them to serious medication errors and adverse drug events, yet structured ICU medication safety programmes are absent from most teaching hospitals in South East Nigeria. This study designed a medication safety programme for intensive care units at teaching hospitals in Enugu and Ebonyi States. A programme development methodology combining ICU medication safety audit, systematic literature review on ICU pharmacy best practices, and stakeholder consensus was employed. A six-month medication error audit at two ICU sites identified an error rate of 8.4 per 100 patient-days, with the highest error categories being wrong dose (31.4 percent) and wrong rate of infusion (24.7 percent). High-alert medications including insulin, concentrated electrolytes, and heparin were involved in 48.6 percent of serious errors. The medication safety programme designed covers high-alert drug management protocols, pharmacist daily ICU rounds, medication reconciliation at ICU admission and discharge, standardised concentration protocols for infusion drugs, double-check procedures for high-alert medications, and monthly safety event review meetings. Implementation guides, ICU pharmacy staffing norms, and outcome metrics are included. Stakeholder consensus review by ten ICU physicians, nurses, and pharmacists confirmed feasibility. The study recommends immediate implementation in both pilot ICUs and calls on the National Postgraduate Medical College to include pharmacist participation in ICU accreditation standards for South East Nigerian teaching hospitals.

Keywords: ICU medication safety, high-alert medications, South East Nigeria, teaching hospital, medication errors