Medication errors when transferring elderly patients between primary health care and hospital care
- 616 Downloads
Objective: The aims were to evaluate the frequency and nature of errors in medication when patients are transferred between primary and secondary care.
Method: Elderly primary health care patients (> 65years) living in nursing homes or in their own homes with care provided by the community nursing system, had been admitted to one of two hospitals in southern Sweden, one university hospital and one local hospital. A total of 69 patient-transfers were included. Of these, 34 patients were admitted to hospital whereas 35 were discharged from hospital.
Main outcome measure: Percentage medication errors of all medications i.e. any error in the process of prescribing, dispensing, or administering a drug, and whether these had adverse consequences or not.
Results: There were 142 medication errors out of 758 transfers of medications. The patients in this study used on an average more than 10 drugs before, during and after hospital stay. On an average, there were two medication errors each time a patient was transferred between primary and secondary care. When patients were discharged from the hospital, the usage of a specific medication dispensing system constituted a significant risk for medication errors. The most common error when patients were transferred to the hospital was inadvertent withdrawal of drugs. When patients left the hospital the most common error was that drugs were erroneously added.
Conclusion: Medication errors are common when elderly patients are transferred between primary and secondary care. Improvement in documentation and transferring data about elderly patients’ medications could reduce these errors. The specific medication dispensing system that has been used in order to increase safety in medication dispensing does not seem to be a good instrument to reduce the number of errors in transferring data about medication.
KeywordsDrug related problems Drug use Elderly Integrated care Medication errors Pharmaceutical care Sweden
Unable to display preview. Download preview PDF.
- Straand, J, Rokstad, KS. 1999Elderly patients in general practice: diagnoses, drugs and inappropriate prescriptionsA report from the More & Romsdal Prescription Study. Fam Pract.163808Google Scholar
- The National Board of Health and Welfare. [Diagnoses and drug prescriptions – a national survey] Stockholm: The National Board of Health and Welfare, 1999Google Scholar
- The National Board of Health and Welfare. [Drug use in nursing homes: special report 1999:1] Stockholm: The National Board of Health and Welfare, 1999Google Scholar
- Seymour RM, Routledge PA. Important drug–drug interactions in the elderly. Drugs Aging 1998; 12(6): 485–94Google Scholar
- Veehof, L, Stewart, R, Haaijer-Ruskamp, F, Jong, BM. 2000The development of polypharmacyA longitudinal study. Fam Pract.172617Google Scholar
- Hallas, J, Harvald, B, Worm, J, Beck-Nielsen, J, Gram, LF, Grodum E., etal. 1993Drug related hospital admissionsResults from an intervention program. Eur J Clin Pharmacol.45199203Google Scholar
- WHO Collaborating Centre for Drug Statistics Methodology. Anatomical Therapeutic Chemical (ATC) Classification Index. Oslo: World Health Organisation, 2000. http://www.whocc.no/atcddd (accessed 12 May 2004)Google Scholar
- Kam, WJ, Meyboomde Jong, B, Tromp, TF, Moorman, PW, Lei, J. 2001Effects of electronic communication between the GP and the pharmacistThe quality of medication data on admission and after discharge. Fam Pract.186059Google Scholar