Duplicate prescriptions in the emergency department: a retrospective cohort study

Abstract

Purpose To determine the nature and frequency of duplicate prescriptions (DPs) in the emergency department (ED) by utilization of a novel categorization of DPs which differentiates between appropriate DPs (ADPs) and potentially inappropriate DPs (PIDPs). Methods In this retrospective cohort study, adult patients who presented to the ED for internal medicine of a large university hospital in northern Germany in 2018 and 2019 were screened for the presence of DPs. Descriptive statistical methods were used to characterize the nature and frequency of PIDPs compared to the frequency of ADPs. Results A total of 4208 patients were enrolled into the study. The median age of the study population was 63 years (interquartile range (IQR) 48–77), 53.9% were female. The patients took a median of 5 drugs (IQR 3–9). 10.9% of the study population were affected by at least one PIDP (at least one grade-1 PIDP: 6.1%; at least one grade-2 PIDP: 4.5%; at least one grade-3 PIDP: 1.1%). Non-opioid analgesics accounted for the majority of grade-1 PIDPs, while inhalatives were most frequently responsible for grade-2 and grade-3 PIDPs. Nearly half of the study population (48.6%) displayed at least one ADP. Conclusion PIDPs pose a frequent pharmacological challenge in the ED. The medication review should comprise a systematic screening for PIDPs with a particular focus on non-opioid analgesics and inhalatives. ADPs were detected more frequently than PIDPs, questioning the predominant notion in the medical literature that DPs are exclusively deleterious.

Characteristics of clinical-pharmacological recommendations in psychiatry in Germany

“…30 In the present study, we applied the novel categorization of duplicate prescriptions by Heck et al, which fundamentally distinguishes between appropriate and potentially inappropriate duplicate prescriptions. 10,11 In this study, potentially inappropriate duplicate prescriptions mostly involved combinations of sedatives such as benzodiazepines, Z-drugs, and low-potency first-generation antipsychotics. This corroborates previous findings by colleagues, who also found sedatives to be major contributors to potentially inappropriate duplicate prescriptions in patients with psychiatric disorders.…”

“…Patient medications were reviewed by an interdisciplinary team of physicians comprising attending psychiatrists, a neurologist, and a clinical pharmacologist. The medication reviews covered the following topics (non-exhaustive list): checks for drug–drug interactions, correction of imprecise prescriptions or medication errors, (re-)evaluation of indications/contraindications, management of ADRs, and management of potentially inappropriate duplicate prescriptions (defined according to Heck et al) 10 , 11 ; management of potential prescription omissions; time point, frequency, or duration of drug administration; posology; and therapeutic drug monitoring. Patients’ medical histories, vital signs, laboratory results, and results from technical examinations (eg.…”

Concordance of emergency department physicians’ decisions on HIV post-exposure prophylaxis with national guidelines: results from a retrospective cohort study

“…The present investigation was conducted as a retrospective cohort study at the ED for internal medicine of Hannover Medical School, a large tertiary care university hospital with an urban catchment area in northern Germany, between 1 January 2018 and 31 December 2019. Of note, the study population was the same as in reference, 12 but with a different research focus (HIV-PEP prescriptions vs duplicate prescriptions). The study period 2018–2019 was selected to preclude an impact of the coronavirus disease 2019 (COVID-19) pandemic on ED statistics (the first COVID-19 case in Germany was confirmed on 27 January 2020 13 ).…”

The Nudging Effect of a Reminder Letter to Reduce Duplicated Medications

“…3 Given that medicine is the most common therapeutic intervention, polypharmacy has become an inevitable consequence. 4 Unfortunately, it is also associated with potentially inappropriate medication use and medication duplication, [5][6][7] which may lead to a lower quality of life, falls, hospital admission, emergency department visits, and increased health care costs. [8][9][10][11][12][13][14] Since prescription-related problems are prevalent worldwide, 6,[14][15][16][17] improving the appropriateness of medication is a major public health concern that needs attention.…”