Exploring discharge prescribing errors and their propagation post-discharge: an observational study

Abstract

Background Discharge prescribing error is common. Little is known about whether it persists post-discharge. Objective To explore the relationship between discharge prescribing error and post-discharge medication error. Setting This was a prospective observational study (March-May 2013) at an adult academic hospital in Ireland. Method Patients using three or more chronic medications pre-admission, with a clinical pharmacist documented gold-standard pre-admission medication list, having a chronic medication stopped or started in hospital and discharged to home were included. Within 10-14 days after discharge a gold standard discharge medication was prepared and compared to the discharge prescription to identify differences. Patients were telephoned to identify actual medication use. Community pharmacists, general practitioners and hospital prescribers were contacted to corroborate actual and intended medication use. Post-discharge medication errors were identified and the relationship to discharge prescribing error was explored. Main outcome measured Incidence, type, and potential severity of post-discharge medication error, and the relationship to discharge prescribing. Results Some 36 (43 %) of 83 patients experienced post-discharge medication error(s), for whom the majority (n = 31, 86 %) were at risk of moderate harm. Most (58 of 66) errors were discharge prescribing errors that persisted post-discharge. Unintentional prescription of an intentionally stopped medication; error in the dose, frequency or formulation and unintentional omission of active medication are the error types most likely to persist after discharge. Conclusion There is a need to implement discharge medication reconciliation to support medication optimisation post-hospitalisation.

Prevalence and Nature of Medication Errors and Medication-Related Harm Following Discharge from Hospital to Community Settings: A Systematic Review

“…The definition of a DRP was provided in six studies [53,56,58,76,79,81] out of the cohort of 27 studies that mentioned outcome definitions. Error categories were mentioned in 14 studies [23, 24, 60, 61, 65, 70-72, 75, 81, 85, 87, 90, 97] but were only defined in five studies [60,72,75,85,87]. The outcome denominator was clearly defined in all papers and the data collection method was described clearly in all but one study [91].…”

“…In total, 12 studies [23,65,71,72,75,85,87,89,90,96,97,99] reported data concerning the frequency of MEs. Six studies used established definitions of MEs [23,71,72,75,85,87], with one study developing their own definition [90], and five not reporting any definition [65,89,96,97,99]. Five studies [71,72,87,90,97] reported data specifically concerning prescribing errors, of which two [72,87] used the prescribing error definition proposed by Dean et al [101].…”

“…All studies explicitly used the number of discharged patients as their denominator. Seven studies that used patients affected by at least one ME as their numerator are summarised below [23,72,75,87,89,96,99]. Across five studies from three settings that reported ME rates per discharged patient [23,87,89,96,99], a median of 53% [IQR 33-60.5%] of adult and elderly patients experienced MEs post-discharge.…”

“…One study [72] reported that one or more prescribing errors affected 43% of discharged patients. Another study [87] reported that 3.5% of discharge medications were affected by at least one monitoring error post-discharge.…”

“…[72], three ADR studies [62,64,91], nine ADE studies [24, 54-56, 61, 69, 78, 80, 94] and five UMD studies [59,66,70,88,95]. Seven studies [54,61,62,64,72,78,80] reported severity assessment based on existing rating scales published in the literature. Of these, three studies [54,61,78] used the severity rating proposed by Bates et al [32], with various other scales being used by remaining studies.…”