Influence of hospitalization on prescribing safety across the continuum of care: an exploratory study

Abstract

BackgroundTransitions between different levels of healthcare, such as hospital admission and discharge, pose a considerable threat to the quality and continuity of drug therapy. This study aims to further explore the current role of hospitalization in prescribing error exposure and medication-related communication as patients are transferred from and back to ambulatory care.MethodsAssisted by electronic decision support, pre-admission and discharge medication regimens of 187 adult patients in a German university hospital were comparatively screened for clinically relevant categories of potentially inadequate prescribing. Binary logistic regression analyses were conducted to identify risk factors predisposing individuals to prescribing errors as a result of hospitalization. Additionally, it was established to what extent medication changes and potentially inappropriate prescribing decisions originating from inpatient treatment were communicated in discharge letters.Results94.7% of the patients are subjected to differences between pre-admission and discharge prescriptions occurring at a rate of 461 per 100 hospitalizations. However, these modifications in drug therapy do not have a significant effect on the total number of potential prescribing errors per patient (p = 0.135) even though a large potential for improvement exists throughout the care continuum. For instance, almost a quarter of study participants with impaired kidney function lacks appropriate dose adjustment for one or more drugs before onset and at the end of inpatient treatment alike (22.5% [95% CI: 13.5%-34.0%] vs. 22.8% [95% CI: 14.1%-33.6%]). Overall, the probability of error exposure following hospitalization rises with an increasing number of prescribed drugs per patient, while individuals treated on surgical wards are four times more likely to be discharged with a prescribing-related safety hazard than their counterparts from medical departments (OR: 4.069 [95% CI: 1.126-14.703]; p = 0.032). In the study population’s discharge summaries only 14.8% of medication changes and none of the potentially inappropriate prescribing decisions made during inpatient care are addressed, despite the latter occurring at a rate of 91 per 100 hospitalizations.ConclusionsThere is urgent need for standardized and evidence-based measures contributing to patient safety across sectorial interfaces of drug therapy. Our findings provide useful orientation for the targeted and rational design of such improvement strategies.

Transition of care: A set of pharmaceutical interventions improves hospital discharge prescriptions from an internal medicine ward

“…Changes in medication are made for almost every hospitalised patient [11]. As previously demonstrated, changes in drug regimen during hospitalisation are frequent, as they are during the immediate period after hospital discharge.…”

“…Another aspect of the transition between hospital and community care concerns treatment changes at each step; these changes occur for more than 95% of hospitalised patients [11]. They can induce misunderstandings for patients, incomplete information and communication at transition steps, and thus induce medication errors and decreases in medication safety [12,13].…”

Scoring-Tool zu Identifizierung von Patienten mit erhöhtem Risiko für Arzneimittel-bezogene Probleme- Bericht einer Punkt-Prävalenzuntersuchung bei Aufnahme im Krankenhaus

“…21 % der Patienten erhalten mindestens ein nicht korrekt dosiertes bzw. kontraindiziertes Medikament [13]. Die Durchführung einer bestmöglichen Medikationsanamnese ermöglicht die umfassende und strukturierte Erfassung und Evaluation der Medikation zum Zeitpunkt der Aufnahme im Krankenhaus [14].…”

Structure and Content of Drug Monitoring Advices Included in Discharge Letters at Interfaces of Care: Exploratory Analysis Preceding Database Development

“…Indeed, up to 10% of all hospital readmissions occur as a consequence of ADE, and nearly 1 in 4 of these ADE is caused by drugs just started during the index hospitalization [1,3-5]. Since during hospitalization, more than 95% of all prehospital drug therapies are modified, appropriate follow-up monitoring is particularly important [6-9]. Furthermore, in the discharge medication, over half of the drugs are newly prescribed during hospitalization, emphasizing the need for closer monitoring during the initial postdischarge phase [8].…”