Medication Discrepancies in Discharge Summaries and Associated Risk Factors for Elderly Patients with Many Drugs

Abstract

Background and Objective Elderly patients are at high risk for medication errors in care transitions. The discharge summary aims to counteract drug-related problems due to insufficient information transfer in care transitions, hence the accuracy of its medication information is of utmost importance. The purpose of this study was to describe the medication discrepancy rate and associated risk factors in discharge summaries for elderly patients. Methods Pharmacists collected random samples of discharge summaries from ten hospitals in southern Sweden. Medication discrepancies, organisational, and patient-and care-specific factors were noted. Patients aged ≥ 75 years with five or more drugs were further included. Descriptive and logistic regression analyses were performed. Results Discharge summaries for a total of 933 patients were included. Average age was 83.1 years, and 515 patients (55%) were women. Medication discrepancies were noted for 353 patients (38%) (mean 0.87 discrepancies per discharged patient, 95% confidence interval 0.76-0.98). Unintentional addition of a drug was the most common discrepancy type. Central nervous system drugs/analgesics were most commonly affected. Major risk factors for the presence of discrepancies were multi-dose drug dispensing (adjusted odds ratio 3.42, 95% confidence interval 2.48-4.74), an increasing number of drugs in the discharge summary (adjusted odds ratio 1.09, 95% confidence interval 1.05-1.13) and discharge from departments of surgery (adjusted odds ratio 2.96, 95% confidence interval 1.55-5.66). By contrast, an increasing number of drug changes reduced the odds of a discrepancy (adjusted odds ratio 0.93, 95% confidence interval 0.88-0.99). Conclusions Medication discrepancies were common. In addition, we identified certain circumstances in which greater vigilance may be of considerable value for increased medication safety for elderly patients in care transitions.

Risk factors for hospital readmission in older adults within 30 days of discharge – a comparative retrospective study

“…Neither can we be certain that the non-significant difference between groups in regard to transfer of information to the primary care centre is correct and there is no way of telling if the patient actually received or took part of the contents of their discharge summary or not. Previous studies do, however, show that discharge summaries are often lacking in content and quality [49,50] as is the transfer of these to the next caregiver [50]. Even though the discharge summary, medication report and medications list are considered to be helpful to the GPs, their use of the information provided is often lacking due to the uneven quality as well as the discrepancies found in the medications lists included [49][50][51].…”

“…Even though the discharge summary, medication report and medications list are considered to be helpful to the GPs, their use of the information provided is often lacking due to the uneven quality as well as the discrepancies found in the medications lists included [49][50][51]. These deficits lead to risks of medication errors and ADEs for older patients in transitions of care [49,52] and could be part of the reason as to why older adults living in the community with home care have increased odds of readmission as compared to those living in nursing homes.…”

“…According to Caleres et al [49] discharge summaries from surgical departments are more often found to include discrepancies than those from other departments. This could, following our reasoning that these discrepancies could cause ADEs, be part of the explanation as to why patients discharged from surgical units were more at risk of being readmitted in the present study.…”

From Paper to E-Prescribing of Multidose Drug Dispensing: A Qualitative Study of Workflow in a Community Care Setting

“…The MDD system is used in the Nordic countries and the Netherlands [ 15 ]. Compared to patients with ordinary prescribing, patients with MDD have fewer serious drug–drug interactions in their medication lists [ 16 , 17 ] and higher medication adherence [ 18 , 19 ] but are also more prone to medication errors in care-level transitions and inappropriate prescribing [ 17 , 20 , 21 , 22 ].…”

A study to investigate the impact of a clinical pharmacist on post take ward round medication communication, prescribing and appropriateness

“…Additionally, the impact of the intervention may be enhanced by optimising the skills and knowledge of medical officers by: Understanding the role of the PTWR pharmacist: Further clarity around the role and expectations placed upon the PTWR pharmacist should lead to a more collaborative approach and acceptance of pharmacist recommendations (188); • Communication/Teamwork: Improved communication and teamwork between multidisciplinary team members will assist the ward round team to develop a coordinated Plan of Care(1); and • Teaching on the Run: Teaching on the Run sessions are designed to further enable medical officers to apply sound teaching and learning principles in the ward round (and other workplace) environment(198).As well improved communication and teamwork, these suggestions will improve the PTWR learning environment for medical officers and pharmacists alike.Regarding handover to the patient and primary health care providers on discharge from hospital, our findings found no difference in the number of patients for which a pharmacist-prepared list of discharge medications was provided. The importance of a clinical handover as a patient transitions between hospital and community is well recognised(199,200), with professional colleges and the Australian Commission for Safety and Quality in Health Care Committee supporting that clear medication information should be provided on discharge(1), ideally by a pharmacist(201). To further critically evaluate the comparisons between patient cohorts, Phase Three of this research looked at the impact the risk rating of recommendations has on the subsequent actions taken.…”