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Journal Article > Study
Association of ICU or hospital admission with unintentional discontinuation of medications for chronic diseases.
Bell CM, Brener SS, Gunraj N, et al. JAMA. 2011;306:840-847.
Care transitions are a vulnerable time for patients, particularly following hospitalization when discharge communication, pending tests, and medication reconciliation are all known challenges. This study analyzed a population-based data set containing both hospitalization and outpatient prescription records to identify the incidence of potentially unintentional medication discontinuation among patients 66 years or older. Analyzing nearly 400,000 patients, investigators found high rates of medication discontinuation ranging from 5% to 19% across 5 evidence-based medication classes (e.g., lipid lowering, thyroid replacement, antiplatelet agents) for hospitalized patients. Admission to the ICU was associated with an even greater risk of medication discontinuation. While some medication discontinuation is not surprising in the setting of a critical illness that may create new contraindications to preexisting medications, both this study and an accompanying editorial [see link below] raise appropriate concern about carefully reconciling chronic disease medications following hospitalization. A past AHRQ WebM&M conversation and perspective discussed the challenges and opportunities for improving care transitions.
Committee on Identifying and Preventing Medication Errors, Aspden P, Wolcott J, Bootman JL, Cronenwett LR, eds. Washington, DC: The National Academies Press; 2007.
A major report by the Institute of Medicine (IOM) on medication errors suggests that, despite all the progress in patient safety since To Err is Human, medication errors remain extremely common, and the health care system can do much more to prevent them. Among the startling statistics from this report: more than 1.5 million Americans are injured every year in American hospitals, and the average hospitalized patient experiences at least one medication error each day. The report emphasizes actions that health care systems, providers, funders, and regulators can take to improve medication safety. These actions include having all US prescriptions written and dispensed electronically by 2010, more widespread use of medication reconciliation, and additional research on drug errors and how to prevent them. Importantly, the report also emphasizes actions that patients can take to prevent medication errors, such as maintaining active medication lists and bringing their medications to appointments. Support for the IOM report came from the Centers for Medicare & Medicaid Services.
Journal Article > Study
Coleman EA, Smith JD, Raha D, Min S. Arch Intern Med. 2005;165:1842-1847.
This study suggests that nearly 15% of patients discharged after hospitalization experience a medication discrepancy. Using data from 375 adults, investigators also discovered that the contributing factors to these discrepancies were split among patient- and system-related issues. The five most common medication classes implicated were anticoagulants, diuretics, angiotensin-converting enzyme inhibitors, lipid-lowering agents, and proton pump inhibitors. The authors conclude that use of a medication discrepancy tool can identify problems leading to medical errors, poor quality of care for chronic conditions, and unsafe transitions across care settings.