Medication-Related Hospital Readmissions Within 30 Days of Discharge: Prevalence, Preventability, Type of Medication Errors and Risk Factors

Abstract

Background: Hospital readmission rates are increasingly used as a measure of healthcare quality. Medicines are the most common therapeutic intervention but estimating the contribution of adverse drug events as a cause of readmissions is difficult.Objectives: To assess the prevalence and preventability of medication-related readmissions within 30 days after hospital discharge and to describe the risk factors, type of medication errors and types of medication involved in these preventable readmissions.Design: A cross-sectional observational study.Setting: The study took place across the cardiology, gastroenterology, internal medicine, neurology, psychiatry, pulmonology and general surgery departments in the OLVG teaching hospital, Netherlands.Participants: Patients with an unplanned readmission within 30 days after discharge from an earlier hospitalization (index hospitalization: IH) were reviewed.Measurements: The prevalence and preventability of medication-related readmissions were assessed by residents in multidisciplinary meetings. A senior internist and hospital pharmacist reassessed the prevalence and preventability of identified cases. Generalized estimating equation with logistic regression was performed to identify risk factors of potentially preventable medication-related readmissions.Results: Of 1,111 included readmissions, 181 (16%) were medication-related, of which 72 (40%) were potentially preventable. The number of medication changes at IH (Adjusted odds ratio [ORadj]: 1.14; 95% CI: 1.05–1.24) and having ≥3 hospitalizations 6 months before IH (ORadj: 2.11; 95% CI: 1.12–3.98) were risk factors of a preventable medication-related readmission. Of these preventable readmissions, 35% were due to prescribing errors, 35% by non-adherence and 30% by transition errors. Medications most frequently involved were diuretics and antidiabetics.Conclusion: This study shows that 16% of readmissions are medication-related, of which 40% are potentially preventable. If the results are confirmed in larger multicentre studies, this may indicate that more attention should be paid to medication-related harm in order to lower the overall readmission rates.

Medication-Related Readmissions: Documentation of the Medication Involved and Communication in the Care Continuum

“…A pharmacy team member explained medication changes to the patient and communicated these to the next healthcare providers. Further details are described in the main study (Uitvlugt et al 2021). steps (van der Does et al 2020; Uitvlugt et al 2021).…”

“…Further details are described in the main study (Uitvlugt et al 2021). steps (van der Does et al 2020; Uitvlugt et al 2021). Initially, a research coordinator (medical doctor) screened all readmissions to determine whether they met inclusion criteria.…”

“…Moreover, a senior internist and hospital pharmacist validated all MRRs, as identified at the multidisciplinary meetings. Finally, FIGURE 1 | Process of causality and preventability assessments of readmissions (Uitvlugt et al, 2021;van den Bemt and Egberts 2007;van der Does et al, 2020;Warlé-van Herwaarden et al, 2015). Prescribing errors were defined as medication errors, among others, dosing errors, contra-indications, drug interactions, omission errors or overdosing.…”

“…A systematic review reported that 21% of readmissions were medication-related, and 69% of these were potentially preventable ( El Morabet et al, 2018 ). A recent Dutch study with 1,111 readmissions showed that 16% of readmissions were medication-related, of which 40% were potentially preventable ( Uitvlugt et al, 2021 ). Polypharmacy, medication changes during index admission (IA) and hospitalizations before IA could increase the risk of an MRR for elderly patients ( Uitvlugt et al, 2021 ).…”

Effects of a transitional care programme on medication adherence in an older cardiac population: A randomized clinical trial

“…22 In this secondary analysis, CCB patients were excluded if they did not use any high-risk medications pre-admission or post-discharge, or had less than 360 days of data on adherence pre-admission. The included high-risk medications, those associated with preventable medication-related hospital admissions, 19,20,24 are presented in Table 1 on the therapeutic subgroup level according to the Anatomic Therapeutic Classification (ATC) system code. 25 Insulin, loop diuretics and 'pro re nata (as needed)' medications were excluded (Appendix Table A1).…”