Reducing Enteral Feeding Tube Medication Errors in ICUs: A Multicenter Before-after Study of Education and Clinical Pharmacist Interventions in Türkiye

Background: This study aimed to evaluate the prevalence of enteral feeding tube-related medication administration errors in intensive care units (ICUs) and to assess the impact of structured education combined with clinical pharmacist interventions on reducing these errors. Methods: This multicenter, prospective before-after study was conducted over 7 months (June-December 2025) in the intensive care units of 3 tertiary-care hospitals in Istanbul, Türkiye. Adult patients (≥18 y) hospitalized for ≥24 hours and receiving at least one medication through an enteral feeding tube were included. The study comprised pre-education (3 mo), education (15 d), and post-education (3 mo) periods. During the education phase, clinical pharmacists delivered structured training supported by a decision-support flowchart for enteral medication administration. Active pharmacist recommendations were provided throughout the post-education period. Errors were defined as the administration of dosage forms inherently unsuitable for enteral tube delivery—specifically, modified-release and enteric-coated formulations that should not be crushed, split, or otherwise manipulated. Results: A total of 242 patients were analyzed (pre-education: n=136; post-education: n=106). The proportion of patients experiencing at least one enteral feeding tube-related medication administration error decreased significantly from 92.6% to 55.6% after education ( P <0.001), with a further reduction to 52.8% following pharmacist recommendations. The median number of errors per patient declined from 2 (interquartile range 1-3) to 1 (interquartile range 0-2) ( P <0.001). Conclusions: Enteral feeding tube-related medication administration errors were highly prevalent in the studied intensive care units, and structured educational interventions combined with clinical pharmacist involvement effectively reduced their frequency. Whether these findings are generalizable to other settings warrants further investigation.