Careful medication management in long-term care residents is associated with improved hospital readmission rates and reduced fall rates. In the UK, pharmacist independent prescribers (PIP) can initiate, change, or monitor medications, and this cluster randomized controlled trial evaluated the effect of PIPs on fall rates. After six months of PIP involvement, fall rates (the primary outcome) were not statistically different than the usual care group, although drug burden was reduced.

Remote delivery of care, such as telehealth and e-prescribing, increased sharply at the beginning of the COVID-19 pandemic. This rapid review was conducted to determine the types and frequency of medication safety incidents associated with remote delivery of primary care prior to the pandemic. Fifteen articles were identified covering medication safety and e-prescribing; none of these studies associated medication safety and telehealth.

Primary care rapidly shifted to telehealth and virtual visits at the start of the COVID-19 pandemic. This study asked general practitioners (GPs) and pharmacists in Ireland about the impact of technology (i.e., virtual visits, electronic prescribing) on medication safety since the pandemic began. Both groups identified electronic prescribing as the most significant workflow change. GPs did not perceive a change in medication safety incidents due to electronic prescribing; pharmacists reported a slight increase in incidents.

Interprofessional communication is critical to safe medication management during transitions of care. Researchers conducted this ethnographic study to explore inter- and intra-professional communications during older adults’ transitions of care. Communication was influenced by the transferring setting, receiving setting, and ‘real-time’ communication. Lack of, or poor, communication impacted medication safety; researchers recommend more proactive communication and involvement of the pharmacist.

After an older adult has a fall, medication deprescribing is a crucial intervention to prevent future harm. This study of a large sample of elderly patients in Ireland found that they were frequently prescribed medications that increased their risk of falling, and deprescribing was rare after a fall-related hospitalization. A WebM&M commentary discussed tactics to more safely manage older patients' medications.

Transitions of care represent a vulnerable time for patients. Older adults in particular may experience a variety of challenges related to such transitions, including managing changes to their medications. This systematic review suggests that there is significant opportunity for health care providers to improve family engagement in managing medications of elderly patients during care transitions.

This retrospective cohort study of patients age 65 and older on chronic medications found that unintentional medication discontinuation does occur following hospitalization. As with prior studies, medication documentation in hospital discharge summaries remains highly variable.

Elderly patients are at greater risk of experiencing adverse drug events than the adult population as a whole. Older patients are more likely to be frail, have more medical conditions, and are physiologically more sensitive to injury from certain classes of medication. Researchers examined a large cohort of Irish outpatients age 65 and older to determine the relationship between hospital discharge and potentially inappropriate medication prescribing. Approximately half of the 38,229 patients studied were prescribed a medication in contravention to the STOPP criteria. The risk of potentially inappropriate prescribing increased after hospital discharge, even when using multiple statistical techniques to control for medical complexity. An accompanying editorial delineates various vulnerabilities that predispose older patients to adverse events during the transition from hospital to home. A recent PSNet perspective discussed community pharmacists' role in promoting medication safety.

Combination medications are frequently used to improve adherence, but they may also contribute to medication errors. Using pharmacy claims data, researchers found that the prescribing of antihypertensive fixed-dose combination medication was associated with a greater risk of therapeutic duplication.

This systematic review identified 25 randomized controlled trials of methods to improve medication reconciliation at the time of hospital discharge, most of which involved a pharmacist-mediated intervention. Overall, there was no clear evidence that medication reconciliation interventions reduced either medication discrepancies or adverse drug events. A previous commentary discussed the challenges in implementing effective medication reconciliation programs in real-world settings.

Although certain medication classes pose increased risks to children, well-defined criteria for potentially inappropriate prescribing for pediatric patients have not been established. This study described an iterative consensus-building process which identified 12 indicators of potentially inappropriate medications for children. Future studies will test the validity of these indicators.

Older patients are more vulnerable to adverse drug events, and a key safety strategy is to avoid prescribing high-risk medications to these patients. This systematic review found that pharmacist medication review and clinical decision support, as well as combined approaches, were modestly effective at reducing high-risk prescribing for older patients. The authors suggest that further studies are needed to identify more effective means of promoting safe prescribing for this vulnerable population.

… health IT can be optimized to reduce medication errors. … Clyne B, Bradley MC, Hughes C, Fahey T, Lapane KL. Electronic prescribing and other forms …

This study describes the development of improved alerts and alternate treatment algorithms to reduce the number of adverse drug events associated with potentially inappropriate medication use in the elderly.

Users of an electronic prescribing decision support system reported that they frequently overrode drug safety warnings, generally due to a perception that many alerts were unnecessary.

This AHRQ-funded study found that nursing home employees were more likely to have a positive opinion of the workplace culture of safety when the survey was distributed on site rather than mailed.

The authors determined that evaluation guidelines for Centers for Medicare and Medicaid Services surveyors were ineffective in minimizing the use of inappropriate medications in nursing homes.

This Agency for Healthcare Research and Quality (AHRQ)–supported study discovered a need to better address safety culture in nursing homes, drawing on findings from a self-reported survey. Investigators surveyed more than 360 nurses and 630 nursing assistants on different aspects of safety. These included overall safety perception, teamwork within units, communication, actions promoting safety, and support for patient safety. Although the findings suggest areas for improvement, the authors appropriately point out that their modified tool wasn't designed specifically for nursing homes. This setting creates unique challenges but also affects elderly patients who tend to be at higher risk for adverse events, making safety initiatives critical.

An information technology–based intervention, which identified nursing home patients at high risk for adverse drug events and recommended customized management strategies, successfully reduced the risk of delirium.