Unwanted incidents during transition of geriatric patients from hospital to home: a prospective observational study

Abstract

BackgroundGeriatric patients recently discharged from hospital experience increased chance of unplanned readmissions and admission to nursing homes. Several studies have shown that medication-related discrepancies are common. Few studies report unwanted incidents by other factors than medications. In 2002 an ambulatory team (AT) was established within the Department of Geriatrics, St. Olavs University Hospital HF, Trondheim, Norway. The AT monitored the transition of the patients from hospital to home and four weeks after discharge in order to reveal unwanted incidents.The aim of the present study was to describe unwanted incidents registered by the AT among patients discharged from a geriatric evaluation and management unit (GEMU) by character, frequency and stage in the transitional process. Only unwanted incidents with a severity making contact with the primary health care (PHC) necessary were registered.MethodsA prospective observational study with patients treated in the GEMU and followed by the AT was performed. Current practice included comprehensive geriatric assessment and management including discharge planning in the GEMU and collaboration with the primary health care on appointments on assistance to be provided after discharge from hospital. Unwanted incidents severe enough to induce contact with the primary health care were registered during the transitional phase and after discharge.Results118 patients (65% female), with mean age 83.2 ± 6.4 years participated. Median Barthel Index at discharge was 18 (interquartile range 16-19) and median Mini Mental Status Examination 24 (interquartile range 21-26). A total of 146 unwanted incidents were registered in 70 (59%) of the patients. Most frequent were unwanted incidents related to drug prescription regime (32%), exchange of information in and between the GEMU and the primary health care (25%) and service or help provided from the PHC (17%).ConclusionsDespite a seemingly well-organised system for transition of patients from the GEMU to their homes, one or more unwanted incidents occurred in most patients during discharge or four weeks post discharge. The study has revealed areas of importance for improving transitional care of geriatric patients.

Pharmacist-Coordinated Multidisciplinary Hospital Follow-up Visits Improve Patient Outcomes

“…This difference in readmission rate between groups was even greater than that seen in the primary analysis. (8) 13 (7) Number of medication changes at discharge 4 (4) 4 (4) Days between hospital discharge and follow-up visit (1,0); stroke (2,0); electrolyte imbalance (1,1); hemorrhage (2,0); blood clot (2,1); altered mental status (3,2); endocrine disorders other than diabetes (1,0); gastrointestinal disorders (5,8); and chest pain, noncardiac (3,0). IQR = interquartile range.…”

“…[5][6][7] In the geriatric population, the most frequently reported unwanted events after discharge were related to prescription medication regimens mainly due to patients getting incorrect drugs or dosages. 8 Literature to date shows that some pharmacist interventions before and after discharge decrease medication-related errors. Pharmacist counseling before discharge improves overall medication adherence after discharge from 34.8% to 55.2% when compared with standard of care (i.e., information session with a nurse).…”

Transitional Care Strategies From Hospital to Home

“…1 A broad spectrum of adverse events can occur after discharge, including both diagnostic and therapeutic errors, but ADEs are particularly common and harmful, leading to hospitalizations and readmissions. 4,5 Recent studies indicate that nearly 100 000 elderly patients are hospitalized every year due to ADEs. 6 Patients with stroke represent a population at high risk of recurrent cerebrovascular events, recurrent hospitalization within 1 year of the index admission, higher rates of disability, and increased mortality.…”

Sikkerhetstiltak for legemidler i sykehjem

“…Weaknesses in patient record systems have previously been documented at 56 Norwegian nursing homes (8). Another study shows that errors in medication information was one of the most common adverse events when patients are transferred between different levels of the health service (34). Nor do error reports function satisfactorily as safety measures.…”