Reducing unplanned hospital readmissions is a priority patient safety focus, and numerous interventions with hospital pharmacists have been developed. In this study, hospitalized adults aged 70 years and older were randomized to receive standard care or the IMMENSE intervention. The IMprove MEdicatioN Safety in the Elderly (IMMENSE) intervention is based on the integrated medicine management (IMM) model and consists of five steps, including medication reconciliation, patient counseling, and communication with the patient’s primary care provider. There was no significant difference in emergency department visits or readmissions between control and intervention within 12 months of the index hospital visit.

Polypharmacy in older adults is an ongoing safety concern due to the risk of being prescribed a potentially inappropriate medication or co-prescription of medications with dangerous interactions. In this study of adults aged 65 and older with chronic pain, 54% were taking at least one potentially inappropriate medication and 43% were at moderate or high risk of adverse drug events. Measures such as involvement of a pharmacist in medication review could reduce risk of adverse drug events in older adult outpatients.

Older adults are at high risk for 30-day unplanned hospital readmission. This study identified patient-level risk factors among patients 75 years or older who were initially hospitalized for fall-related injuries. Risk factors included being a male, abnormal concentration of C-reactive protein, and anemia. Discharge programs targeting these patients could reduce 30-day unplanned readmissions.

Older adults, particularly those taking more than one medication, are at increased risk of adverse drug events (ADE). In this study of 6,545 older adult patients who were prescribed at least 3 medications, multidrug interactions (MDI) were identified in 1.3% of medication lists. Psychotropic medications were the most commonly involved medication class; the most common serious ADE were serotonin syndrome, seizures, prolonged QT interval, and bleeding.

Common high-risk medications such as antiplatelets and non-steroidal anti-inflammatory drugs (NSAIDs) have the potential to cause serious patient harm. This randomized trial examined the usefulness of an existing intervention to support safer prescribing in general practice to improve safe high-risk prescribing.

… over- and undertriage. … Fuller  G, Pandor A, Essat M, et al. Diagnostic accuracy of prehospital triage tools for …

… possible areas for improvement. … Alboksmaty A, Kumar S, Parekh R, et al. Management and patient safety of complex …

This article describes the development and use of a workflow chart to assist individuals without experience to successfully carry out a root cause analysis.

Researchers analyzed medication errors occurring in the trauma service of a single university hospital in Spain to inform the development and implementation of a set of measures to improve the safety of the pharmacotherapeutic process. The Multidisciplinary Hospital Safety Group proposed improvement measures that intend to involve pharmacists in medication reconciliation, increase the use of medication reconciliation in the emergency and trauma departments, and incorporate protocols and alerts into the electronic prescribing system.

Residential care facilities have been challenged by COVID-19. This story examines the weakness of care processes in nursing homes in Europe that have been revealed due to the pandemic. Data gaps, resource allocation choices, and hospital space considerations are noted situations that have resulted in unintended consequences, reducing the safety of care for this at-risk population. 

This analysis found that only 23% of older adults in the Emergency Department had complete agreement between self-reported medications and pharmacy dispensing records. Over half of patients omitted antibiotics from self-report, which can result in adverse events, as antibiotics can have potentially fatal interactions with many medications.

This study evaluated the impact of an electronic decision support tool comprising a comprehensive drug review to support deprescribing and reduce polypharmacy in elderly adults. Results indicate that the tool did reduce the number of prescribed drugs but did not significantly reduce unplanned hospital admissions or death after 24 months.

The value of medication reviews in reducing adverse drug events (ADEs) is now generally accepted although robust evidence of cost or clinical effectiveness of such reviews is lacking. For this pilot study of patients in a French nursing home, ADE risk scores were calculated before and six months after a pharmacist-led multidisciplinary review of each patient’s medications. Significant drops in ADE risk scores, as well as reductions in the number of patients taking at least one potentially inappropriate medication and substantial cost savings for the nursing home, are reported in this preliminary assessment.

This study reviewed mandatory reporting of patient-controlled analgesia device-related events to the Food and Drug Administration postmarketing surveillance database. Less that 10% of reported events were deemed adverse events, and the vast majority of these were preventable. The authors call for development and adoption of patient-controlled analgesia devices with improved safety features and better training.

The use of double checks by two nurses is a strategy to minimize the risk of medication administration error. This randomized controlled trial investigated the effectiveness of double checks in a simulated patient care scenario. The investigators found that double checking did increase rates of error identification compared to single checking, but many errors still went undetected. A prior qualitative study found that double checking is often variably implemented, with clinicians having differing perceptions on how to perform the process effectively.

… better characterize this patient safety issue. … Locquet M, Honvo G, Rabenda V, et al. Adverse health events related …

… reduce polypharmacy and improve patient safety. … Carroll C, Hassanin A. Polypharmacy in the Elderly-When Good Drugs …

This commentary describes how one hospital established a resident leader to embed quality improvement and patient safety education into daily care processes. The authors review strategies the resident leader championed to drive improvement, including quarterly hospital-wide morbidity and mortality conferences, mock root cause analyses, and a feedback mechanism to respond to resident concerns.

Strategies to educate residents and fellows in quality and patient safety concepts can ensure commitment to improvement work. This commentary describes the development and results of a multispecialty program to expand an existing academic medical center curriculum on quality improvement.

Previous studies have found that older patients experience high rates of adverse drug events and are often prescribed inappropriate medications. This commentary discusses a quality improvement project aimed at reducing avoidable adverse drug events that used prescribing criteria, a checklist, and plan-do-study-act methods to help identify potentially inappropriate medications prescribed in a unit, educate and raise awareness about the medications among health care workers, and remove the medications from the ward.