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Influence of hospitalization on prescribing safety across the continuum of care: an exploratory study.

von Klüchtzner W, Grandt D - BMC Health Serv Res (2015)

Bottom Line: However, these modifications in drug therapy do not have a significant effect on the total number of potential prescribing errors per patient (p = 0.135) even though a large potential for improvement exists throughout the care continuum.There is urgent need for standardized and evidence-based measures contributing to patient safety across sectorial interfaces of drug therapy.Our findings provide useful orientation for the targeted and rational design of such improvement strategies.

View Article: PubMed Central - PubMed

Affiliation: University of Duisburg-Essen, Essen, Germany. wilko.kluechtzner@uni-duisburg-essen.de.

ABSTRACT

Background: Transitions between different levels of healthcare, such as hospital admission and discharge, pose a considerable threat to the quality and continuity of drug therapy. This study aims to further explore the current role of hospitalization in prescribing error exposure and medication-related communication as patients are transferred from and back to ambulatory care.

Methods: Assisted by electronic decision support, pre-admission and discharge medication regimens of 187 adult patients in a German university hospital were comparatively screened for clinically relevant categories of potentially inadequate prescribing. Binary logistic regression analyses were conducted to identify risk factors predisposing individuals to prescribing errors as a result of hospitalization. Additionally, it was established to what extent medication changes and potentially inappropriate prescribing decisions originating from inpatient treatment were communicated in discharge letters.

Results: 94.7% of the patients are subjected to differences between pre-admission and discharge prescriptions occurring at a rate of 461 per 100 hospitalizations. However, these modifications in drug therapy do not have a significant effect on the total number of potential prescribing errors per patient (p = 0.135) even though a large potential for improvement exists throughout the care continuum. For instance, almost a quarter of study participants with impaired kidney function lacks appropriate dose adjustment for one or more drugs before onset and at the end of inpatient treatment alike (22.5% [95% CI: 13.5%-34.0%] vs. 22.8% [95% CI: 14.1%-33.6%]). Overall, the probability of error exposure following hospitalization rises with an increasing number of prescribed drugs per patient, while individuals treated on surgical wards are four times more likely to be discharged with a prescribing-related safety hazard than their counterparts from medical departments (OR: 4.069 [95% CI: 1.126-14.703]; p = 0.032). In the study population's discharge summaries only 14.8% of medication changes and none of the potentially inappropriate prescribing decisions made during inpatient care are addressed, despite the latter occurring at a rate of 91 per 100 hospitalizations.

Conclusions: There is urgent need for standardized and evidence-based measures contributing to patient safety across sectorial interfaces of drug therapy. Our findings provide useful orientation for the targeted and rational design of such improvement strategies.

No MeSH data available.


Related in: MedlinePlus

Number of patients affected by specific types of potentially inadequate prescribing at admission (blue bars) versus discharge (purple bars). *: p < 0.05; **: p < 0.01.
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Fig2: Number of patients affected by specific types of potentially inadequate prescribing at admission (blue bars) versus discharge (purple bars). *: p < 0.05; **: p < 0.01.

Mentions: However, an in-depth analysis of the error pattern that patients are exposed to reveals significant alterations associated with hospitalization (Figure 2). Clinically relevant drug-drug interactions as well as omissions of indicated medication affect more patients at discharge than at admission. In contrast, merely the relatively small frequency of patients with redundant prescriptions is further reduced during inpatient treatment. Meanwhile, patient exposure to other, more prevalent types of potentially inadequate prescribing such as dosing errors are not altered significantly between admission and discharge. For instance, at both points in time almost a quarter of patients with impaired kidney function lacks appropriate dose adjustment for one or more drugs (Figure 3).Figure 2


Influence of hospitalization on prescribing safety across the continuum of care: an exploratory study.

von Klüchtzner W, Grandt D - BMC Health Serv Res (2015)

Number of patients affected by specific types of potentially inadequate prescribing at admission (blue bars) versus discharge (purple bars). *: p < 0.05; **: p < 0.01.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4494641&req=5

Fig2: Number of patients affected by specific types of potentially inadequate prescribing at admission (blue bars) versus discharge (purple bars). *: p < 0.05; **: p < 0.01.
Mentions: However, an in-depth analysis of the error pattern that patients are exposed to reveals significant alterations associated with hospitalization (Figure 2). Clinically relevant drug-drug interactions as well as omissions of indicated medication affect more patients at discharge than at admission. In contrast, merely the relatively small frequency of patients with redundant prescriptions is further reduced during inpatient treatment. Meanwhile, patient exposure to other, more prevalent types of potentially inadequate prescribing such as dosing errors are not altered significantly between admission and discharge. For instance, at both points in time almost a quarter of patients with impaired kidney function lacks appropriate dose adjustment for one or more drugs (Figure 3).Figure 2

Bottom Line: However, these modifications in drug therapy do not have a significant effect on the total number of potential prescribing errors per patient (p = 0.135) even though a large potential for improvement exists throughout the care continuum.There is urgent need for standardized and evidence-based measures contributing to patient safety across sectorial interfaces of drug therapy.Our findings provide useful orientation for the targeted and rational design of such improvement strategies.

View Article: PubMed Central - PubMed

Affiliation: University of Duisburg-Essen, Essen, Germany. wilko.kluechtzner@uni-duisburg-essen.de.

ABSTRACT

Background: Transitions between different levels of healthcare, such as hospital admission and discharge, pose a considerable threat to the quality and continuity of drug therapy. This study aims to further explore the current role of hospitalization in prescribing error exposure and medication-related communication as patients are transferred from and back to ambulatory care.

Methods: Assisted by electronic decision support, pre-admission and discharge medication regimens of 187 adult patients in a German university hospital were comparatively screened for clinically relevant categories of potentially inadequate prescribing. Binary logistic regression analyses were conducted to identify risk factors predisposing individuals to prescribing errors as a result of hospitalization. Additionally, it was established to what extent medication changes and potentially inappropriate prescribing decisions originating from inpatient treatment were communicated in discharge letters.

Results: 94.7% of the patients are subjected to differences between pre-admission and discharge prescriptions occurring at a rate of 461 per 100 hospitalizations. However, these modifications in drug therapy do not have a significant effect on the total number of potential prescribing errors per patient (p = 0.135) even though a large potential for improvement exists throughout the care continuum. For instance, almost a quarter of study participants with impaired kidney function lacks appropriate dose adjustment for one or more drugs before onset and at the end of inpatient treatment alike (22.5% [95% CI: 13.5%-34.0%] vs. 22.8% [95% CI: 14.1%-33.6%]). Overall, the probability of error exposure following hospitalization rises with an increasing number of prescribed drugs per patient, while individuals treated on surgical wards are four times more likely to be discharged with a prescribing-related safety hazard than their counterparts from medical departments (OR: 4.069 [95% CI: 1.126-14.703]; p = 0.032). In the study population's discharge summaries only 14.8% of medication changes and none of the potentially inappropriate prescribing decisions made during inpatient care are addressed, despite the latter occurring at a rate of 91 per 100 hospitalizations.

Conclusions: There is urgent need for standardized and evidence-based measures contributing to patient safety across sectorial interfaces of drug therapy. Our findings provide useful orientation for the targeted and rational design of such improvement strategies.

No MeSH data available.


Related in: MedlinePlus