The Relationship Between Medication Discrepancies and Hospitalization Risk Among Patients With Advanced CKD

Abstract

This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). M edication discrepancies are common in medicine, posing an ongoing threat to safe patient care. Discrepancies can be defined as any difference between the physician's records and the medications that the patient actually takes, including related dose and frequency. In clinical practice, medication discrepancies are common, occurring in 34% to 95% of patients newly admitted to hospitals. 1,2 The results of a systematic review indicated that 11% to 59% of discrepancies were clinically relevant, 3 and that 39% could potentially cause moderate to severe harm. 1 We have previously reported that medication discrepancies are particularly common in patients with advanced chronic kidney disease (CKD; estimated glomerular filtration rate 0 to 30 ml/min per 1.73 m 2 ) not yet on dialysis, with 55% of patients having at least 1 discrepancy. 4 It is likely that mismatches between patients' medication use and the physician's record are more of a problem in chronic diseases. These patients are often treated with a large number of drugs 5 and are cared for by multiple physicians. This is certainly true in advanced CKD, in which care can become fragmented because of the large number of collaborating care providers and suboptimal communication.The relationship between medication discrepancies and subsequent hospitalizations has been rarely studied in advanced CKD. 6 There are clear reasons to believe that such a relationship would exist. Patients with advanced CKD probably have a high rate of hospitalizations. Improper use of medications could lead to hospitalizations through adverse effects of misused drugs, medical complications, and diminution of anticipated efficacy. In the current study we have analyzed the relationship between the number medication discrepancies in advanced CKD and the risk for hospitalizations over up to a year of follow-up. RESULTSWe enrolled 713 patients with stage 4 to 5 CKD into the baseline cohort, with characteristics displayed in Table 1. The population skewed toward older age, with 62.7% being >65 years. There was a minor underrepresentation of Hispanic patients; comprising only 9% of patients. The vast majority of patients were hypertensive and approximately 50% had diabetes mellitus. During the 1-year assessment period, 23 patients died and 33 patients reached end-stage renal disease. A further 5 patients were lost to follow-up.A total of 392 patients (55.0% of the study population) had at least 1 medication discrepancy. The median number of discrepancies per patient (in patients with at least 1 discrepancy) was 2, (interquartile range, 1-4). A total of 646 patients (90.6%) had 0-5 discrepancies, 56 (7.8%) had 6-10 discrepancies, and 11 (1.5%) had more than 10 discrepancies. Types of discrepancies included patients taking a medication not on the nephrologist's list, patients not taking a medication on the nephrologist's list, different doses, and different dose frequencies. Medication...

Digital Applications Targeting Medication Safety in Ambulatory High-Risk CKD Patients

“…Although this study was not adequately powered to evaluate whether eKidneyCare can avert serious ADRs, we did observe a 60% rate reduction in discrepancies that could seriously harm patients and result in emergency room visits and hospitalization. The possibility of increased health care utilization is supported by recent evidence demonstrating an association between medication discrepancies and hospitalization in patients with CKD (28). Finally, eKidneyCare breaks down medication data silos, which studies have shown magnify medication errors (29,30), by allowing all users access to a common clinic pharmacy database and through secure communication channels, seamlessly connecting all stakeholders so that issues surrounding medication safety can be addressed quickly and efficiently.…”

Community pharmacists’ perspectives on assessing kidney function and medication dosing for patients with advanced chronic kidney disease: A qualitative study using the theoretical domains framework

“…5,6 Considering these factors, the risk for adverse drug events is high. [7][8][9][10][11][12][13][14] Improperly prescribed medications in CKD have led to adverse outcomes. 15,16 A recent Canadian primary care resource outlined key CKD medications to be dose adjusted or avoided.…”