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Pharmacy World & Science

, 30:840 | Cite as

Clinical outcomes from the use of Medication Report when elderly patients are discharged from hospital

  • Patrik Midlöv
  • Eva Deierborg
  • Lydia Holmdahl
  • Peter Höglund
  • Tommy Eriksson
Research Article

Abstract

Objective The objective of this study was to investigate whether a Medication Report also can reduce the number of patients with clinical outcomes due to medication errors. Method A prospective intervention study with retrospective controls on patients at three departments at Lund University Hospital, Sweden that where transferred to primary care. The intervention group, where patients received a Medication Report at discharge, was compared with a control group with patients of the same age, who were not given a Medication Report when discharged from the same ward one year earlier. For patients with at least one medication error all contacts with hospital or primary care within 3 months after discharge were identified. For each contact it was evaluated whether this was caused by the medication error. We also compared medication errors that have been evaluated as high or moderate clinical risk with medication errors without clinical risk. Main outcome measures Need for medical care in hospital or primary care within three months after discharge from hospital. Medical care is readmission to hospital as well as visits of study population to primary and out-patient secondary health care. Results The use of Medication Report reduced the need for medical care due to medication errors. Of the patients with Medication Report 11 out of 248 (4.4%) needed medical care because of medication errors compared with 16 out of 179 (8.9%) of patients without Medication Report (p = 0.049). The use of a Medication Report significantly reduced the risk of any consequences due to medication errors, p = 0.0052. These consequences included probable and possible care due to medication error as well as administrative procedures (corrections) made by physicians in hospital or primary care. Conclusions The Medication Report seems to be an effective tool to decrease adverse clinical consequences when elderly patients are discharged from hospital care.

Keywords

Clinical outcomes Discharge planning Drug-related problems Medication errors Seamless care Sweden 

Notes

Acknowledgments

We thank the students Linda Andersson, Hanna Fredricson, and Nilla Swärdén for collecting all information on the patients’ drugs.

Funding

The department of Primary Care Development, The department of Research and Development in the county of Skåne, Apoteket AB and the Faculty of Medicine, Lund University.

References

  1. 1.
    Straand J, Rokstad KS. Elderly patients in general practice: diagnoses, drugs and inappropriate prescriptions. A report from the More & Romsdal Prescription Study. Fam Pract. 1999;4:380–8. doi: 10.1093/fampra/16.4.380.CrossRefGoogle Scholar
  2. 2.
    Hanlon JT, Lindblad CI, Hajjar ER, McCarthy TC. Update on drug-related problems in the elderly. Am J Geriatr Pharmacother. 2003;1:38–43. doi: 10.1016/S1543-5946(03)80014-4.PubMedCrossRefGoogle Scholar
  3. 3.
    Hepler CD, Strand LM. Opportunities and responsibilities in pharmaceutical care. Am J Hosp Pharm. 1990;3:533–43.Google Scholar
  4. 4.
    Leape LL. Preventing adverse drug events. Am J Health Syst Pharm. 1995;4:379–82.Google Scholar
  5. 5.
    Kwan Y, Fernandes OA, Nagge JJ, Wong GG, Huh JH, Hurn DA, et al. Pharmacist medication assessments in a surgical preadmission clinic. Arch Intern Med. 2007;10:1034–40. doi: 10.1001/archinte.167.10.1034.CrossRefGoogle Scholar
  6. 6.
    Bates DW, Boyle DL, Vander Vliet MB, Schneider J, Leape L. Relationship between medication errors and adverse drug events. J Gen Intern Med. 1995;4:199–205. doi: 10.1007/BF02600255.CrossRefGoogle Scholar
  7. 7.
    Haw C, Stubbs J, Dickens G. An observational study of medication administration errors in old-age psychiatric inpatients. Int J Qual Health Care. 2007;4:210–6. doi: 10.1093/intqhc/mzm019.CrossRefGoogle Scholar
  8. 8.
    Lisby M, Nielsen LP, Mainz J. Errors in the medication process: frequency, type, and potential clinical consequences. Int J Qual Health Care. 2005;1:15–22. doi: 10.1093/intqhc/mzi015.CrossRefGoogle Scholar
  9. 9.
    Williams EI, Fitton F. Factors affecting early unplanned readmission of elderly patients to hospital. BMJ. 1988;6651:784–7.CrossRefGoogle Scholar
  10. 10.
    Glintborg B, Andersen SE, Dalhoff K. Insufficient communication about medication use at the interface between hospital and primary care. Qual Saf Health Care. 2007;1:34–9. doi: 10.1136/qshc.2006.019828.CrossRefGoogle Scholar
  11. 11.
    Midlov P, Bergkvist A, Bondesson A, Eriksson T, Hoglund P. Medication errors when transferring elderly patients between primary health care and hospital care. Pharm World Sci. 2005;27(2):116–20. doi: 10.1007/s11096-004-3705-y.PubMedCrossRefGoogle Scholar
  12. 12.
    Midlov P, Holmdahl L, Eriksson T, Bergkvist A, Ljungberg B, Widner H, et al. Medication report reduces number of medication errors when elderly patients are discharged from hospital. Pharm World Sci. 2008;30(1):92–8. doi: 10.1007/s11096-007-9149-4.PubMedCrossRefGoogle Scholar
  13. 13.
    Mjorndal T, Boman MD, Hagg S, Backstrom M, Wiholm BE, Wahlin A, et al. Adverse drug reactions as a cause for admissions to a department of internal medicine. Pharmacoepidemiol Drug Saf. 2002;1:65–72. doi: 10.1002/pds.667.CrossRefGoogle Scholar
  14. 14.
    The Uppsala Monitoring Centre. The use of the WHO-UMC system for standardised case causality assessment [homepage on the Internet]. [cited June 2008]; 2008. Available from: http://www.who-umc.org/graphics/4409.pdf
  15. 15.
    Bates DW, Spell N, Cullen DJ, Burdick E, Laird N, Petersen LA, et al. The costs of adverse drug events in hospitalized patients. Adverse Drug Events Prevention Study Group. JAMA. 1997;4:307–11. doi: 10.1001/jama.277.4.307.CrossRefGoogle Scholar
  16. 16.
    Classen DC, Pestotnik SL, Evans RS, Lloyd JF, Burke JP. Adverse drug events in hospitalized patients. Excess length of stay, extra costs, and attributable mortality. JAMA.. 1997;4:301–6. doi: 10.1001/jama.277.4.301.CrossRefGoogle Scholar
  17. 17.
    Kaushal R, Bates DW, Landrigan C, McKenna KJ, Clapp MD, Federico F, et al. Medication errors and adverse drug events in pediatric inpatients. JAMA. 2001;16:2114–20. doi: 10.1001/jama.285.16.2114.CrossRefGoogle Scholar
  18. 18.
    Al-Rashed SA, Wright DJ, Roebuck N, Sunter W, Chrystyn H. The value of inpatient pharmaceutical counselling to elderly patients prior to discharge. Br J Clin Pharmacol. 2002;6:657–64. doi: 10.1046/j.1365-2125.2002.01707.x.CrossRefGoogle Scholar
  19. 19.
    Vira T, Colquhoun M, Etchells E. Reconcilable differences: correcting medication errors at hospital admission and discharge. Qual Saf Health Care. 2006;2:122–6. doi: 10.1136/qshc.2005.015347.CrossRefGoogle Scholar
  20. 20.
    Gleason KM, Groszek JM, Sullivan C, Rooney D, Barnard C, Noskin GA. Reconciliation of discrepancies in medication histories and admission orders of newly hospitalized patients. Am J Health Syst Pharm. 2004;16:1689–95.Google Scholar

Copyright information

© Springer Science+Business Media B.V. 2008

Authors and Affiliations

  • Patrik Midlöv
    • 1
    • 2
  • Eva Deierborg
    • 3
  • Lydia Holmdahl
    • 4
  • Peter Höglund
    • 5
  • Tommy Eriksson
    • 3
  1. 1.Tåbelund Primary Health Care CentreEslövSweden
  2. 2.Department of Clinical Sciences in Malmö - General Practice/Family MedicineLund UniversityLundSweden
  3. 3.Hospital PharmacyLund University HospitalLundSweden
  4. 4.Department of MedicineLund University HospitalLundSweden
  5. 5.Department of Clinical PharmacologyLund UniversityLundSweden

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