Posthospital medication discrepancies: prevalence and contributing factors.

BACKGROUND Despite the national attention being given to the problem of medication safety, little attention has been paid to the medication problems that are encountered by older patients who are receiving care across settings. The objective of this study was to determine the prevalence and contributing factors associated with posthospital medication discrepancies. METHODS The study population consisted of community-dwelling adults aged 65 years and older admitted to the hospital with 1 of 9 selected conditions (n = 375). A geriatric nurse practitioner performed a comprehensive medication assessment in the patient's home within 24 to 72 hours after institutional discharge. The assessment focused on what older patients reported taking in comparison with the prehospital medication regimen and the posthospital medication regimen. Prevalence and types of medication discrepancies were categorized using the Medication Discrepancy Tool. RESULTS A total of 14.1% of patients experienced 1 or more medication discrepancies. Using the Medication Discrepancy Tool, 50.8% of identified contributing factors for discrepancies were categorized as patient-associated, and 49.2% were categorized as system-associated. Five medication classes accounted for half of all medication discrepancies. Medication discrepancies were associated with the total number of medications taken and the presence of congestive heart failure. A total of 14.3% of the patients who experienced medication discrepancies were rehospitalized at 30 days compared with 6.1% of the patients who did not experience a discrepancy (P = .04). CONCLUSIONS A significant percentage of older patients experienced medication discrepancies after making the transition from hospital to home. Both patient-associated and system-associated solutions may be needed to ensure medication safety during this vulnerable period.

[1]  Screening discharge prescriptions. , 1988, American journal of hospital pharmacy.

[2]  N. Col,et al.  The role of medication noncompliance and adverse drug reactions in hospitalizations of the elderly. , 1990, Archives of internal medicine.

[3]  M. Beers,et al.  Compliance with medication orders among the elderly after hospital discharge. , 1992, Hospital formulary.

[4]  M. Bull.  Patients' and professionals' perceptions of quality in discharge planning. , 1994, Journal of nursing care quality.

[5]  Geriatric Home Assessment After Hospital Discharge , 1994, Journal of the American Geriatrics Society.

[6]  C. Patterson.  Joint Commission on Accreditation of Healthcare Organizations , 1995, Infection Control & Hospital Epidemiology.

[7]  L. Iezzoni,et al.  Patient-physician communication at hospital discharge and patients' understanding of the postdischarge treatment plan. , 1997, Archives of internal medicine.

[8]  T A Brennan,et al.  Factors associated with unplanned hospital readmission among patients 65 years of age and older in a Medicare managed care plan. , 1999, The American journal of medicine.

[9]  D W Baker,et al.  Health literacy among Medicare enrollees in a managed care organization. , 1999, JAMA.

[10]  Barbara Gage,et al.  Impact of the BBA on Post-Acute Utilization , 1999, Health care financing review.

[11]  J. Mahoney,et al.  Adverse Drug Events in Elderly Patients Receiving Home Health Services following Hospital Discharge , 1999, The Annals of pharmacotherapy.

[12]  E. Cook,et al.  Drug complications in outpatients , 2000, Journal of general internal medicine.

[13]  D. Woods,et al.  Gaps in the continuity of care and progress on patient safety , 2000, BMJ : British Medical Journal.

[14]  R. Goldberg,et al.  Discrepancies in the use of medications: their extent and predictors in an outpatient practice. , 2000, Archives of internal medicine.

[15]  L. Kohn,et al.  To Err Is Human : Building a Safer Health System , 2007 .

[16]  Alastair Baker,et al.  Crossing the Quality Chasm: A New Health System for the 21st Century , 2001, BMJ : British Medical Journal.

[17]  K. Kerr,et al.  The impact of follow-up telephone calls to patients after hospitalization. , 2002, The American journal of medicine.

[18]  J. Mahoney,et al.  Medication Adherence in Elderly Patients Receiving Home Health Services following Hospital Discharge , 2001, The Annals of pharmacotherapy.

[19]  R. Resar,et al.  Medication Safety: One Organization's Approach to the Challenge , 2001 .

[20]  Alan J. Forster,et al.  Poster Abstract: Electronically Screening Discharge Summaries for Adverse Medical Events , 2002, J. Am. Medical Informatics Assoc..

[21]  A. Coquard,et al.  Preventable and Non-Preventable Risk Factors for Adverse Drug Events Related to Hospital Admissions in the Elderly , 2002 .

[22]  H. Chrystyn,et al.  The value of inpatient pharmaceutical counselling to elderly patients prior to discharge. , 2002, British journal of clinical pharmacology.

[23]  A. Kramer,et al.  Development and testing of a measure designed to assess the quality of care transitions , 2002, International journal of integrated care.

[24]  M. Verhoef,et al.  Understanding coordination of care from the consumer's perspective in a regional health system. , 2002, Health Services Research.

[25]  D. Makuc,et al.  Health, United States, 2003; with chartbook on trends in the health of Americans , 2003 .

[26]  E. Coleman.  Falling Through the Cracks: Challenges and Opportunities for Improving Transitional Care for Persons with Continuous Complex Care Needs , 2003, Journal of the American Geriatrics Society.

[27]  A. Kramer,et al.  The Care Transitions Intervention: A Patient-Centered Approach to Ensuring Effective Transfers Between Sites of Geriatric Care , 2003, Home health care services quarterly.

[28]  D. Bates,et al.  The Incidence and Severity of Adverse Events Affecting Patients after Discharge from the Hospital , 2003, Annals of Internal Medicine.

[29]  E. Marcantonio,et al.  Delirium among newly admitted postacute facility patients: prevalence, symptoms, and severity. , 2003, The journals of gerontology. Series A, Biological sciences and medical sciences.

[30]  E. Coleman,et al.  A new tool for identifying discrepancies in postacute medications for community-dwelling older adults. , 2004, The American journal of geriatric pharmacotherapy.

[31]  T. Lewis.  Using the NO TEARS tool for medication review , 2004, BMJ : British Medical Journal.

[32]  Muhammad Mamdani,et al.  Continuity of care and patient outcomes after hospital discharge , 2004, Journal of General Internal Medicine.

[33]  Janet M. Corrigan,et al.  Key Capabilities of an Electronic Health Record System: Letter Report , 2004 .

[34]  R. Resar,et al.  Standardization as a mechanism to improve safety in health care. , 2004, Joint Commission journal on quality and safety.

[35]  Sung-joon Min,et al.  Posthospital care transitions: patterns, complications, and risk identification. , 2004, Health services research.

[36]  S. Gavi,et al.  Adverse events due to discontinuations in drug use and dose changes in patients transferred between acute and long-term care facilities. , 2004, Archives of internal medicine.

[37]  Robert A Berenson,et al.  Lost in Transition: Challenges and Opportunities for Improving the Quality of Transitional Care , 2004, Annals of Internal Medicine.

[38]  Eric A. Coleman,et al.  Case Studies of Electronic Health Records in Post-Acute and Long-Term Care , 2004 .

[39]  C. Marano,et al.  To err is human. Building a safer health system , 2005 .

[40]  J. Wisnivesky,et al.  Medical errors related to discontinuity of care from an inpatient to an outpatient setting , 2003, Journal of General Internal Medicine.