Frequency of undocumented medication discrepancies in discharge letters after hospitalization of older patients: a clinical record review study

Graabæk, Trine; Terkildsen, Babette Gorm; Lauritsen, Kira Emilie; Almarsdottír, Anna Birna

doi:10.1177/2042098619858049

Cited by 19 publications

(17 citation statements)

References 25 publications

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“…Medication changes were common, as expected considering the older, multimorbid patient population. Nine out of ten patients had at least one change in their medication treatment and the mean number of changes per patient (3) was well in line with previous studies of the same age group [ 6 , 33 , 34 ]. The high prevalence of medication changes during hospitalisation indicates the importance of a thorough and well structured follow-up process after the discharge of older patients.…”

Section: Discussionsupporting

confidence: 88%

Assessment of requests for medication-related follow-up after hospital discharge, and the relation to unplanned hospital revisits, in older patients: a multicentre retrospective chart review

et al. 2021

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Background The discharge of older hospitalised patients is critical in terms of patient safety. Inadequate transfer of information about medications to the next healthcare provider is a known problem, but there is a lack of understanding of this problem in settings where shared electronic health records are used. The aims of this study were to evaluate the prevalence of patients for whom hospitals sent adequate requests for medication-related follow-up at discharge, the proportion of patients with unplanned hospital revisits because of inadequate follow-up requests, and the association between medication reviews performed during hospitalisation and adequate or inadequate follow-up requests. Methods We conducted a retrospective chart review. The study population was randomly selected from a cluster-randomised crossover trial which included patients 65 years or older who had been admitted to three hospitals in Sweden with shared electronic health records between hospital and primary care. Each patient was assessed with respect to the adequacy of the request for follow-up. For patients where the hospitals sent inadequate requests, data about any unplanned hospital revisits were collected, and we assessed whether the inadequate requests had contributed to the revisits. The association between medication reviews and adequate or inadequate requests was analysed with a Chi-square test. Results A total of 699 patients were included. The patients’ mean age was 80 years; an average of 10 medications each were prescribed on hospital admission. The hospitals sent an adequate request for 418 (60%) patients. Thirty-eight patients (14%) had a hospital revisit within six months of discharge which was related to an inadequate request. The proportion of adequate or inadequate requests did not differ between patients who had received a medication review during hospitalisation and those who had not (p = 0.83). Conclusions The prevalence of patients for whom the hospitals sent adequate follow-up requests on discharge was low. More than one in every ten who had an inadequate request revisited hospital within six months of discharge for reasons related to the request. Medication reviews conducted during hospitalisation did not affect the proportion of adequate or inadequate requests sent. A communication gap still exists despite the usage of a shared electronic health record between primary and secondary care levels.

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Section: Discussionsupporting

confidence: 88%

Assessment of requests for medication-related follow-up after hospital discharge, and the relation to unplanned hospital revisits, in older patients: a multicentre retrospective chart review

et al. 2021

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“…Many documentation errors by use of the EPR systems can be caused by deficiencies in the organizational structure in a care unit, such as patient transfers, something many participants also described in the study, including "poorly written or illegible discharge summaries" (WHO, 2016). "Transitions of care" is also emphasized as a focus area by WHO (2016) as well as in other studies (Graabaek et al, 2019;Patel and Landrigan, 2019). This topic identifies several risk areas related to patient safety that were also discussed by our informants: increased adverse events, delays in receiving appropriate treatment, and lost tests or blood sample results.…”

Section: Discussionmentioning

confidence: 83%

Patient Safety Through Nursing Documentation: Barriers Identified by Healthcare Professionals and Students

Bjerkan

Valderaune

Olsen

2021

Front. Comput. Sci.

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Background: Although access to accurate patient documentation is recognized as a prerequisite for delivering of safe and continuous municipal elderly care, healthcare professionals often fail to provide comprehensive clinical information in an accurate and timely manner. The aim of this study was to understand the perceptions of healthcare professionals and healthcare students regarding existing barriers to patient safety through the performance of documentation practices.Methods: Using a qualitative, exploratory design, this study conducted six focus group interviews with nurses and social educators (n = 12) involved in primary care practice and nursing and social educator bachelor’s degree students from a University College (n = 11). Data were analyzed using qualitative content analysis.Results: Four themes emerged from the analysis, which described barriers to patient safety and quality in documentation practices: “Individual factors,” “Social factors,” “Organizational factors,” and “Technological factors.” Each theme also included several sub-themes.Conclusion: According to the findings, several barriers negatively influenced documentation practices and information exchange, which may place primary care patients in a vulnerable and exposed situation. To achieve successful documentation, increased awareness and efforts by the individual professional are necessary. However, primary care services must facilitate the achievement of these goals by providing adequate resources, clear mission statements, and understandable policies.

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“…Medication errors are frequent in patients with polypharmacy and often occur in relation to transitions in health care such as hospital admission or discharge 1–6 . Patients often do not know exactly which medications they are currently taking, and especially the older patients find it difficult to name their medications 7,8 .…”

Section: Introductionmentioning

confidence: 99%

Causes of discrepancies between medications listed in the national electronic prescribing system and patients' actual use of medications

Bülow

Noergaard

Faerch

et al. 2021

Basic Clin Pharma Tox

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Discrepancies between registered prescriptions and patients' actual use of medications are described as frequent and often resulting in adverse medication events. We aimed to assess the extent of and causes behind discrepancies between medications listed in the Danish national prescription system (Shared Medication Record) and patients' actual use of medications. We prospectively reconciled medication for 260 consecutively admitted polypharmacy patients (>50 years and ≥5 prescriptions) at two hospitals in the Capital Region of Denmark. The type of discrepancies were determined and the cause of the discrepancies were evaluated as primarily caused by (1) the patient (i.e., intentional or unintentional non‐adherence) or (2) the health care system (i.e., lack of appropriate update of the SMR by physicians in primary or secondary care). There was a median of 12 [IQR 9–15] medications listed and 3 [IQR 1–5] medication discrepancies per patient (total n = 925). The majority (53%) of discrepancies were caused by the health care system, 32% were caused by the patients, of which 70% were intentional non‐adherence, and 15% had an indeterminable cause. In conclusion, discrepancies between medications listed in the Shared Medication Record and actual use of medications were frequent and were most often caused by clinicians not updating the prescription information.

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Frequency of undocumented medication discrepancies in discharge letters after hospitalization of older patients: a clinical record review study

Cited by 19 publications

References 25 publications

Assessment of requests for medication-related follow-up after hospital discharge, and the relation to unplanned hospital revisits, in older patients: a multicentre retrospective chart review

Assessment of requests for medication-related follow-up after hospital discharge, and the relation to unplanned hospital revisits, in older patients: a multicentre retrospective chart review

Patient Safety Through Nursing Documentation: Barriers Identified by Healthcare Professionals and Students

Causes of discrepancies between medications listed in the national electronic prescribing system and patients' actual use of medications

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