Association of ICU or Hospital Admission With Unintentional Discontinuation of Medications for Chronic Diseases

Bell, Chaim M.; Brener, S; Gunraj, Nadia; Huo, Cindy Yan; Bierman, Arlene S.; Scales, Damon C.; Bajcar, Jana; Zwarenstein, Merrick; Urbach, David R.

doi:10.1001/jama.2011.1206

Cited by 226 publications

(223 citation statements)

References 56 publications

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“…[4][5][6][7][8][9][10] There was no difference in error rates between patients cared for by hospitalists or cardiology attendings and those cared for by house staff, suggesting that clinical experience and expertise are not adequate protections against medication errors at discharge. By contrast, a recent study of an electronic medication reconciliation intervention demonstrated a reduction in provider errors.…”

Section: Discussionmentioning

confidence: 99%

“…3 A further set of errors can be made at the time of hospital discharge. [4][5][6][7][8][9][10] Errors include unintentional discontinuation of medication on discharge, [4][5][6][7] inappropriate retention of inpatient medications on discharge, 7,8 and inaccurate changes in dosing or frequency. Medication reconciliation inaccuracies accumulating at all these points of transition create substantial risk for medication errors on hospital discharge.…”

Section: Introductionmentioning

confidence: 99%

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Medication Reconciliation Accuracy and Patient Understanding of Intended Medication Changes on Hospital Discharge

et al. 2012

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BACKGROUND: Adverse drug events after hospital discharge are common and often serious. These events may result from provider errors or patient misunderstanding. OBJECTIVE: To determine the prevalence of medication reconciliation errors and patient misunderstanding of discharge medications. DESIGN: Prospective cohort study SUBJECTS: Patients over 64 years of age admitted with heart failure, acute coronary syndrome or pneumonia and discharged to home. MAIN MEASURES:We assessed medication reconciliation accuracy by comparing admission to discharge medication lists and reviewing charts to resolve discrepancies. Medication reconciliation changes that did not appear intentional were classified as suspected provider errors. We assessed patient understanding of intended medication changes through post-discharge interviews. Understanding was scored as full, partial or absent. We tested the association of relevance of the medication to the primary diagnosis with medication accuracy and with patient understanding, accounting for patient demographics, medical team and primary diagnosis. KEY RESULTS: A total of 377 patients were enrolled in the study. A total of 565/2534 (22.3 %) of admission medications were redosed or stopped at discharge. Of these, 137 (24.2 %) were classified as suspected provider errors. Excluding suspected errors, patients had no understanding of 142/205 (69.3 %) of redosed medications, 182/223 (81.6 %) of stopped medications, and 493 (62.0 %) of new medications. Altogether, 307 patients (81.4 %) either experienced a provider error, or had no understanding of at least one intended medication change. Providers were significantly more likely to make an error on a medication unrelated to the primary diagnosis than on a medication related to the primary diagnosis (odds ratio (OR) 4.56, 95 % confidence interval (CI) 2.65, 7.85, p<0.001). Patients were also significantly more likely to misunderstand medication changes unrelated to the primary diagnosis (OR 2.45, 95 % CI 1.68, 3.55), p<0.001). CONCLUSIONS: Medication reconciliation and patient understanding are inadequate in older patients postdischarge. Errors and misunderstandings are particularly common in medications unrelated to the primary diagnosis. Efforts to improve medication reconciliation and patient understanding should not be diseasespecific, but should be focused on the whole patient.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Medication Reconciliation Accuracy and Patient Understanding of Intended Medication Changes on Hospital Discharge

et al. 2012

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“…Regarding the former, deficiencies in transitions of care from in-hospital to out-of-hospital settings are well substantiated by current literature (21,22). Known challenges include discontinuity between inpatient and outpatient clinicians, complex hospital stays, and discharge summaries, which may be overwhelming or inadequate to outpatient clinicians.…”

Section: Discussionmentioning

confidence: 99%

Issues of Survivorship Are Rarely Addressed during Intensive Care Unit Stays. Baseline Results from a Statewide Quality Improvement Collaborative

et al. 2014

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Rationale/Objective: In the context of increasing survivorship from critical illness, many studies have documented persistent sequelae among survivors. However, few evidence-based therapies exist for these problems. Support groups have proven efficacy in other populations, but little is known about their use after an intensive care unit (ICU) stay. Therefore, we surveyed critical care practitioners regarding their hospital's practice regarding discussing post-ICU problems for survivors with patients and their loved ones, communicating with primary care physicians, and providing support groups for current or former patients and families.Methods: A written survey was administered to 263 representatives of 73 hospitals attending the January 2013 annual meeting of the Michigan Health and Hospitals Association Keystone ICU initiative, a quality improvement collaborative focused on enhancing outcomes across Michigan ICUs.Results: There were 174 completed surveys, a 66% response rate. Representatives included staff nurses, nursing leadership, physicians, hospital administrators, respiratory therapists, and pharmacists. Sixty-nine percent of respondents identified at least one issue facing ICU survivors after discharge. The concerns most commonly identified by these ICU practitioners were weakness, psychiatric pathologies, cognitive dysfunction, and transitions of care. However, most respondents did not routinely discuss post-ICU problems with patients and families, and only 20% had a mechanism to formally communicate discharge information to primary care providers. Five percent reported having or being in the process of creating a support group for ICU survivors after discharge.Conclusions: Despite growing awareness of the problems faced by ICU survivors, in this statewide quality improvement collaborative, hospital-based support groups are rarely available, and deficiencies in transitions of care exist. Practice innovations and formal research are needed to provide ways to translate awareness of the problems of survivorship into improved outcomes for patients.

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“…Improving patient awareness of AKD and conditions or symptoms that might require evaluation of kidney function (such as oedema and volume-depleting illness), documenting that AKI and/or AKD has occurred particularly if moderate to severe or persistent, and processes of care including medication reconciliation to facilitate appropriate dosing and nephrotoxin avoidance, might help to alert future care providers to the risk of AKD, reduce the risk of adverse events including recurrent AKI, and potentially improve the probability of recovery 88,[105][106][107] …”

Section: Follow-up Carementioning

confidence: 99%

Acute kidney disease and renal recovery: consensus report of the Acute Disease Quality Initiative (ADQI) 16 Workgroup

et al. 2017

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Association of ICU or Hospital Admission With Unintentional Discontinuation of Medications for Chronic Diseases

Abstract: Patients prescribed medications for chronic diseases were at risk for potentially unintentional discontinuation after hospital admission. Admission to the ICU was generally associated with an even higher risk of medication discontinuation.

Cited by 226 publications

References 56 publications

Medication Reconciliation Accuracy and Patient Understanding of Intended Medication Changes on Hospital Discharge

Medication Reconciliation Accuracy and Patient Understanding of Intended Medication Changes on Hospital Discharge

Issues of Survivorship Are Rarely Addressed during Intensive Care Unit Stays. Baseline Results from a Statewide Quality Improvement Collaborative

Acute kidney disease and renal recovery: consensus report of the Acute Disease Quality Initiative (ADQI) 16 Workgroup

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