Medication errors when transferring elderly patients between primary health care and hospital care

Midlöv, Patrik; Bergkvist, Anna; Bondesson, Åsa Åb; Eriksson, Tommy; Höglund, Peter

doi:10.1007/s11096-004-3705-y

Cited by 94 publications

(92 citation statements)

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“…Limitations in the process, as described below, and also too low a power to detect a significant difference might be the explanation. We have previously developed and shown that the medication report in a discharge summary decreases medication errors, clinical consequences, and health contacts due to errors occurring when patients are discharged from hospital to community health care [18,19]. This study shows a further decrease in error rates by improving the internal hospital discharge process.…”

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confidence: 77%

“…We have previously developed and shown that the medication report in a discharge summary decreases medication errors, clinical consequences, and health contacts due to errors occurring when patients are discharged from hospital to community health care [18,19]. This study shows a further decrease in error rates by improving the internal hospital discharge process.In 2000-2001, we performed a descriptive but otherwise identical study in the same setting to describe the medication error rates [18]. The proportion of medications with medication errors after discharge and return to primary care was 17% and only 46% of the patients had no error at all.…”

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confidence: 77%

“…The latter study also showed a reduction in clinical consequences based on medication errors [20]. In our previous descriptive study, there were an average of 2.4 medication errors per patient at admission to the hospital, and only 15% of the patients had no errors at all [18]. In this study, a medication interview [15] was performed and a correct medication list was created and used for each patient as part of the pharmacist's responsibilities in the LIMM model.…”

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confidence: 81%

“…A step towards improved patient safety is harmonising the use of medical records so that the hospital and primary care can access the same information. Recently this has been introduced in Sweden and is now used by 4 of 21 counties [17].A previous study made by our research group, which addressed medication errors caused by insufficient transfer of information when changing care level, showed that information on every fifth medication was transferred erroneously [18]. At admission to hospital, 29 of 34 patients had at least one medication error and corresponding results at discharge from hospital to community health care showed 19 of 35 patients with errors [18].…”

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confidence: 99%

“…Some patients received medications from a specific medication dispensing system (ApoDos), in which a regional pharmacy ApoDos dispensing unit prepared the dosages and provided the patients with a complete list of all medications used by the patient. Other patients did not use this system and for them, the community health care had medication lists that they filled out manually.The same definition of medication error and the same checklist for documenting the errors as in previous studies were used [18,19]. The definition states that a medication Eur J Clin Pharmacol (2009) 65:1037-1046 1039 error is any error in the process of prescribing, dispensing or administering a drug, whether there are adverse consequences or not [22].…”

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confidence: 99%

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Improved quality in the hospital discharge summary reduces medication errors—LIMM: Landskrona Integrated Medicines Management

Bergkvist

Midlöv

Höglund

et al. 2009

Eur J Clin Pharmacol

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109

114

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Purpose We have developed a model for integrated medicines management, including tools and activities for medication reconciliation and medication review. In this study, we focus on improving the quality of the discharge summary including the medication report to reduce medication errors in the transition from hospital to primary and community care. Methods This study is a longitudinal study with an intervention group and a control group. The intervention group comprised 52 patients, who were included from 1 March 2006 until 31 December 2006, with a break during summer. Inclusion in the control group was performed in the same wards during the period 1 September 2005 until 20 December 2005, and 63 patients were included in the control group. In order to improve the quality of the medication report, clinical pharmacists reviewed and gave feedback to the physician on the discharge summary before patient discharge, using a structured checklist. Medication errors were then identified by comparing the medication list in the discharge summary with the first medication list used in the community health care after the patient had returned home.Results By improving the quality of the discharge summary, patients had on average 45% fewer medication errors per patient (P=0.012). The proportion of patients without medication errors was 63.5% in the control group and 73.1% in the intervention group. However, this increase was not significant (P=0.319). Patients who used a specific medication dispensing system (ApoDos) had a 5.9-fold higher risk of suffering from medication errors than those without this medication dispensing system (P<0.001). Conclusion Review and feedback on errors in the discharge summary, including the medication report and a correct medication list, reduced medication errors during the transfer of information from hospital to primary and community care.Keywords Elderly . Hospital discharge . Inpatients . Medication errors . Medication reconciliation . Medication report IntroductionIn the elderly, the risk of medication errors increases with the number of home medications when admitted to or discharged from hospital [1]. Medication errors can lead to Eur J Clin Pharmacol (2009) severe consequences for the patient, and 20-30% of medication errors have been assessed as potential adverse drug events [2]. A review article reports that of the medication errors identified, 11-59% were thought to be of clinical importance [3]. Various types of medication errors are frequent in hospitals [4,5] and in the interface between care levels [6][7][8][9][10][11][12][13][14][15][16]. Insufficient quality in the transfer of information on a patient's medications has recently been highlighted as one of the most important problems in health care, and international and national programs have been developed for information and help [16]. According to the Institute for Healthcare Improvement, poor communication of medical information at transition points is responsible for as many as 50% of all medication errors and 20...

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confidence: 99%

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confidence: 99%

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Improved quality in the hospital discharge summary reduces medication errors—LIMM: Landskrona Integrated Medicines Management

Bergkvist

Midlöv

Höglund

et al. 2009

Eur J Clin Pharmacol

Self Cite

109

114

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Effect of an In-Hospital Multifaceted Clinical Pharmacist Intervention on the Risk of Readmission

et al. 2018

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Hospital readmissions are common among patients receiving multiple medications, with considerable costs to the patients and society.OBJECTIVE To determine whether a multifaceted pharmacist intervention based on medication review, patient interview, and follow-up can reduce the number of readmissions and emergency department (ED) visits. DESIGN, SETTING, AND PARTICIPANTSThis randomized clinical multicenter study (Odense Pharmacist Trial Investigating Medication Interventions at Sector Transfer [OPTIMIST]) enrolled patients from September 1, 2013, through April 23, 2015, with a follow-up of 6 months completed on October 31, 2015. Consecutive medical patients in an acute admission ward who were 18 years or older and who used 5 or more medications were invited to participate. Of 1873 patients invited to participate, 1499 (80.0%) accepted. The medication review and patient interview were conducted in the hospital and followed up in collaboration with primary care. Analysis was based on intention to treat. INTERVENTIONSThe patients were randomized into 3 groups receiving usual care (no intervention), a basic intervention (medication review), and an extended intervention (medication review, 3 motivational interviews, and follow-up with the primary care physician, pharmacy, and nursing home). MAIN OUTCOMES AND MEASURESThe prespecified primary outcomes were readmission within 30 or 180 days and ED visits within 180 days. The primary composite end point was readmission or an ED visit within 180 days. Secondary outcomes were drug-related readmissions within 30 and 180 days after inclusion, and all-cause mortality and drug-related mortality.RESULTS A total of 1467 patients (679 men [46.3%] and 788 women [53.7%]; median age, 72 years; interquartile range, 63-80 years) were part of the primary analysis, including 498 randomized to usual care, 493 randomized to the basic intervention, and 476 randomized to the extended intervention. The extended intervention had a significant effect on the numbers of patients who were readmitted within 30 days (hazard ratio [HR], 0.62; 95% CI, 0.46-0.84) or within 180 days (HR, 0.75; 95% CI, 0.62-0.90) after inclusion and on the number of patients who experienced the primary composite end point (HR, 0.77; 95% CI, 0.64-0.93). The study showed a nonsignificant reduction in drug-related readmissions within 30 days (HR, 0.65; 95% CI, 0.39-1.09) and within 180 days (HR, 0.80; 95% CI, 0.59-1.08) after inclusion and in deaths (HR, 0.83; 95% CI,. The number needed to treat to achieve the primary composite outcome for the extended intervention (vs usual care) was 12.CONCLUSIONS AND RELEVANCE A multifaceted clinical pharmacist intervention may reduce the number of ED visits and hospital readmissions.TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT03079375

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Cost‐consequence analysis evaluating multifaceted clinical pharmacist intervention targeting patient transitions of care from hospital to primary care

Rasmussen

Ravn-Nielsen

Duckert

et al. 2018

J Am Coll Clin Pharm

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Aims Drug‐related problems are a common complication in the transition from hospital to primary care and are associated with morbidity and increased health care costs. In this study, we evaluated the cost and consequences of a comprehensive pharmaceutical intervention compared with usual care, comprised of a medication review and patient interview before discharge and follow‐up for polypharmacy patients. Methods This economic evaluation was embedded within a randomized clinical trial. Patients were randomized to either the basic intervention group (n = 493) which received a medication review, the extended intervention group (n = 476) which received a medication review, discharge interview, and follow‐up, or the control group (n = 498) which received standard care. Total health care costs were estimated over a period of 180 days at individual patient level from a health sector perspective. Results The mean cost per patient was lower in the intervention groups (basic, €16 748; extended, €15 631) compared with the control group (€17 288), although these differences did not reach statistical significance. The costs of additional time used on medication reviews, patient interviews, and follow‐ups (€88) were outweighed by a decrease in costs of readmissions. The results of the clinical study favored the extended intervention group on clinical outcomes, with statistical significance on a composite of readmissions or emergency department visits within 180 days after inclusion (hazard ratio 0.77, 95% confidence interval 0.64‐0.93). Conclusions This comprehensive pharmaceutical intervention was not costly and positive effects were seen in the clinical outcomes, thereby reaching a decrease in total cost per patient on average. The results thus indicate that the intervention is cost‐effective and that the positive net effects can justify costs of the intervention.

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Medication errors when transferring elderly patients between primary health care and hospital care

Cited by 94 publications

References 21 publications

Improved quality in the hospital discharge summary reduces medication errors—LIMM: Landskrona Integrated Medicines Management

Improved quality in the hospital discharge summary reduces medication errors—LIMM: Landskrona Integrated Medicines Management

Effect of an In-Hospital Multifaceted Clinical Pharmacist Intervention on the Risk of Readmission

Cost‐consequence analysis evaluating multifaceted clinical pharmacist intervention targeting patient transitions of care from hospital to primary care

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