Fatema Alqenae
@alqenaie
Pharmacist, Kuwait Ministry of Health
Medication-related problems are increasingly recognised as a key patient safety issue during the transition from hospital to home. This period can be very challenging for patients as they adjust to changes in their health and daily routines after leaving the hospital, not least of all medications they must take as part of their ongoing recovery. This is known as “post-hospital syndrome”, and is defined as “an acquired, transient condition of generalised risk” affecting some patients post hospital discharge. In March 2017, the World Health Organization (WHO) highlighted the importance of medication safety during care transitions with their campaign "Global Patient Safety Challenge: Medication Without Harm", identifying it as a top priority for action worldwide. Ensuring safe medication practices during this critical time can significantly improve patient outcomes and overall well-being.
Exploring Medication Safety After Hospital Discharge: The Need for Deeper Understanding
There’s been a lot of research on medication safety, and while research has focused on different stages of a patient’s journey, such as during hospital stays or in specific medical specialties, recently more attention has been given to medication safety during transitions of care, such as when a patient is admitted to, or discharged from, the hospital. However, we still don’t fully understand the risks and causes of medication safety incidents that arise following hospital discharge. To address this gap and develop effective strategies to prevent medication errors and harm after discharge, we need a thorough review of available evidence to better understand how common these issues are, how serious they can be, and what exactly causes them.
My PhD research at the University of Manchester aimed to uncover the patterns and causes of medication errors following hospital discharge to improve patient safety during this critical transition. Following are two publications that came out of my PhD studies.
Epidemiology of Medication Errors and Medication Related Harm After Hospital Discharge
The response of the scientific community to our first publication demonstrates the strong interest of the scientific community on this topic, as evidenced by fact it was viewed 37,000 times, cited more than 200 times, widely shared on social media and referenced in policy documents.
This study reviewed 54 international studies from 1990 to 2019 to investigate how often medication mistakes occur after people are discharged from hospital, and to further document the harm these mistakes cause.
Our review found that for both adults and the elderly, post-hospital discharge, a median of one in two patients may be affected by medication errors, and a median of one in five patients may be harmed by their medication.
Higher rates of medication-related error and harm were observed in the elderly. The types of medication most often causing problems were antibiotics, anti-diabetics, analgesics, and cardiovascular drugs (common subclasses were anti-hypertensive and anticoagulant medications). The review shows that more needs to be done to keep patients safe after they go home. By focusing on the common medications that cause issues, healthcare providers can help reduce the risk of medication errors and related harm.
Causes of Medication Errors After Hospital Discharge
Our second study explored medication related incidents that occur following hospital discharge by investigating reports from England and Wales between 2015 and 2019 to understand why these errors occur and how often they happen.
Our analysis of 1121 reports of medication-related incidents found that most of these incidents involved cardiovascular and central nervous system medications administered to elderly patients, and often occurred during drug monitoring and administration. The main reason for these mistakes were problems with how information was shared between different healthcare providers, including lack of co-ordinated care between secondary and primary care, and between healthcare and pharmacy.
Why Are Elderly Patients at Higher Risk for Medication Safety Incidents?
Both studies found that elderly patients are often the most affected by medication errors and related harm, which is consistent with what other studies have found. The elderly are more vulnerable to these problems for several reasons:
- Body Changes: As we age, our bodies process medications differently, which can increase the risk of side effects or interactions.
- Multiple Health Conditions: Elderly patients often have several health issues, making it more complicated to manage their medications safely.
- Taking Many Medications: Older adults frequently take multiple medications, which increases the risk of medication errors or adverse drug events.
Implication for Practice – Improving After Hospital Discharge Care:
Because of these risks, it’s crucial to focus on elderly patients when improving medication safety, especially during transitions of care. Our work suggests this can be done in the following ways:
- Focus on high-risk medication groups: Healthcare staff should pay close attention to high-risk medication groups as potential targets for action to improve patient outcomes. These groups can inform the development of tools to predict medication-related harm, particularly after discharge. Using prescribing safety indicators more strategically, especially for elderly patients prescribed these medications without planned monitoring, can enhance post-discharge care.
- Provide clear prescription information: It's essential to include a clear treatment duration in discharge letters, the need for drug monitoring, along with detailed information about the patient’s clinical case and diagnosis. This helps ensure that medications are prescribed appropriately, and that the treatment plan is well understood by all healthcare providers involved in the patient’s care.
- Enhance communication across care interfaces: Strengthening collaboration between pharmacists and physicians after hospital discharge is crucial. Better communication can ensure continuity of care and reduce the risk of medication errors at this critical stage in the patient’s journey to recovery.
- Offer a dedicated service post-discharge: There may be a need for a service that prioritises patients at high risk of medication safety incidents after hospital discharge such as the elderly, with a focus on high-risk medications.
These two studies highlight that medication errors are a significant risk to patient safety after leaving the hospital. However, we can reduce these errors by paying close attention to the common types of medications involved and improving how care is coordinated. Better communication between healthcare providers is key to ensuring smooth transitions from hospital to home, keeping patients safe, and improving their overall health.
READ MORE:
- H M Krumholz, “Post-hospital syndrome–a condition of generalized risk”, The New England journal of medicine, 2013.
- “Global patient safety challenge: medication without harm”, World Health Organization, 2017.
- F Alqenae, D Steinke, R Keers, “Prevalence and Nature of Medication Errors and Medication-Related Harm Following Discharge from Hospital to Community Settings: A Systematic Review”, Drug Safety, 2020.
- F Alqenae, et al., “Analysis of the nature and contributory factors of medication safety incidents following hospital discharge using National Reporting and Learning System (NRLS) data from England and Wales: a multi-method study”, Therapeutic Advances in Drug Safety, 2023.
- “Medication Safety in Transitions of Care”, World Health Organization, 2019.