When serious adverse events such as death are reported, they are typically associated with poor patient safety. In some fields of care, however, such as palliative care, deaths are expected and not necessarily an indicator of poor quality. This commentary describes how serious and non-serious adverse events (SAEs/AEs) are currently defined and reported, the associated challenges, and proposes a new approach to reporting SAE/AE in clinical trials. A decision-tree to determine SAE/AE reporting based on the new proposed approach is presented.

Hospital at Home (HAH), in which patients receive hospital-level care in their own homes, reduces the risk of hospital-acquired conditions such as delirium, especially in older adults. This commentary provides an overview of HAH, recent developments, and associated regulatory, safety, and quality issues.

In "Hospital at Home" (HaH) programs, patients receive inpatient medical treatment such as intravenous medications, daily laboratory monitoring, and basic imaging in their home under close clinician supervision. Among 50 HaH patients in New York, 22% experienced an adverse drug event. A WebM&M commentary discussed medication challenges unique to the home.

Inaccurate medication reconciliation leads to medication discrepancies and places patients at risk for adverse drug events. Health information exchange can enhance medication safety through improved access to prescribing information. In this cluster-randomized trial, a pharmacist performed medication reconciliation with access to a regional health information exchange for patients admitted to a single hospital in the intervention arm and without such information access for patients in the control arm. In the first 10 months of the study, the health information exchange provided access to prescribing information from large hospitals and a pharmacy insurance plan, but only hospital prescribing information was available during the last 21 months because the insurance plan began charging for data. Although researchers found no significant difference between the intervention and control groups with regard to the number of medication discrepancies, patients who underwent medication reconciliation with access to pharmacy insurance data had a higher number of medication discrepancies identified than control patients. They conclude that charging for pharmacy data interrupted the positive effect of health information exchange on medication reconciliation in the study. A past WebM&M commentary described how lack of access to prescribing information led to an adverse drug event.

This study found that medication reconciliation at hospital admission successfully reduced adverse drug events (ADEs) caused by incorrect admission medication changes. However, the investigators found that appropriate admission medication changes (e.g., withholding antihypertensive medication in a patient presenting with low blood pressure) were also associated with subsequent ADEs, indicating a need for better medication monitoring during hospitalization.

Recent efforts to withhold payment for certain preventable adverse events have increased the importance of determining whether such conditions are present on admission to the hospital. This study found that, if the present-on-admission indicator was not used, the AHRQ Patient Safety Indicators overestimated the incidence of postoperative complications.

The investigators examined the effect of pharmacist-conducted medication reconciliation on the occurrence of discrepancy-related adverse drug events for patients returning to nursing homes after a hospital stay.