Engagement with patients and families about managing medications in critical care units: a mixed methods systematic review

Objective: The objective of this study was to examine how patients and families are engaged in managing medications in critical care units.

Review method used: A mixed methods systematic review was conducted.

Data sources: A search was conducted of five library databases from inception to January 27, 2024, and updated on September 20, 2024, comprising MEDLINE(R) ALL (Ovid), CINAHL Complete (EBSCOhost), PsycINFO (Ovid), Embase (Ovid), and the Cochrane Central Register of Controlled Trials (CENTRAL) (Ovid).

Review methods: Screening, data abstraction, and quality assessments were completed independently and in duplicate. Included studies were mapped onto a continuum across three levels of engagement, which were consultation, involvement, and partnership and shared leadership.

Results: There were 30 studies included. Patients and families were largely engaged through information exchange with health professionals. Patients valued intensive care unit nurses communicating with them as they performed medication activities at the bedside. This communication was considered important regardless of the patients' conscious state. Opportunities for involvement occurred when health professionals asked about patients' and families' needs and preferences for medications. This involvement helped to address symptoms such as pain and anxiety, especially as the patients’ condition improved. There were isolated situations where patients and families were involved in partnerships comprising active decision-making. Interactions between health professionals about medication management during handovers, ward rounds, and informal conversations largely excluded patients and families. Interventional studies had a tenuous focus on patient and family engagement and demonstrated little impact on medication quality and safety.

Conclusions: Patients and families faced power differentials, environmental barriers, and unwavering views about their capabilities to be involved about medication management. Many of the situations identified in included studies can be addressed by improving communication opportunities with the healthcare team. Family members can be included in bedside rounds, be allowed to remain present during procedures, and be provided with a routine scheduled opportunity for discussion.