Pharmacy World & Science

, Volume 32, Issue 5, pp 622–630 | Cite as

Drug related problems after discharge from an Australian teaching hospital

  • Glena R. Ellitt
  • Ellinor Engblom
  • Parisa Aslani
  • Tommy Westerlund
  • Timothy F. ChenEmail author
Research article


Objective To reconcile patients’ medicines and to classify drug related problems identified during medication review conducted after discharge from hospital. Setting Patients were discharged from the cardiology unit of Westmead Hospital after recruitment into the Westmead Medicines Project which ran from 2004 to 2007. Method This retrospective study involved an analysis of drugs, diseases and drug related problems in medication review reports available for 76 out of 85 patients who received a Home Medicines Review (HMR). Data sources for medication reconciliation and analyses also included hospital discharge summaries (n = 70) and GP referrals for HMR (n = 44). Comprehensive clinical profiles were constructed for the 76 subjects whose drug related problems were identified, coded, and then classified from their HMR reports. Main outcome measures Number, type, distribution and international classification of drugs, diseases and drug-related problems. Results Patients were prescribed drugs for a broad range of cardiovascular, circulatory, endocrine, respiratory and digestive system diseases. Mean number of drugs per patient in discharge summaries: 8.7 ± SD 3.3 (range 3–19); in GP referrals: 8.9 ± SD 4.3 (range 2–23); and in HMR reports: 10.8 ± SD 4.0 (range 3–24). Mean number of diseases per patient in discharge summaries: 4.1 ± SD 2.9 (range 1–11); and in HMR reports: 4.7 ± SD 2.6 (range 1–12). A total of 398 drug related problems were identified for 71 (93.3%) patients with mean 5.6 ± SD 4.3 problems (range 1–21). The most frequently recorded problems were the patients’ uncertainty about drug aim: n = 128 (32.0%); potential interactions n = 89 (22.4%); and adverse reactions n = 60 (15.1%). Conclusion This study showed that patients recently discharged from a tertiary care hospital had a significant number of drug related problems. Classification of drugs and diseases revealed a broad range of non-cardiovascular medicines and conditions in the patients from an acute care cardiology unit. We found that home medicines review provided continuity of care and an opportunity for medication reconciliation which revealed marked differences in number of drugs, between hospital discharge and medicines review. The patients’ uncertainly about their drugs and their diverse range of co-morbidities indicated the need for timely counselling by pharmacists in the community.


Australia Cardiovascular Continuity of care Drug related problems Medication reconciliation Medication review 



The authors would like to thank Mr Kingsley Ng and Ms Elizabeth Anderson from the Department of Pharmacy, Westmead Hospital, Sydney West Area Health Service, NSW Australia, for their commitment in reviewing the HMR reports submitted to the research team.


The original research project was externally funded as part of the Research and Development Program, Third Community Pharmacy Agreement, managed by the Pharmacy Guild of Australia, and funded by the Australian Government Department of Health and Ageing.

Conflict of interest

The authors have no conflict of interest to declare.


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Copyright information

© Springer Science+Business Media B.V. 2010

Authors and Affiliations

  • Glena R. Ellitt
    • 1
  • Ellinor Engblom
    • 2
  • Parisa Aslani
    • 1
  • Tommy Westerlund
    • 2
    • 3
  • Timothy F. Chen
    • 1
    Email author
  1. 1.Faculty of Pharmacy A15The University of SydneySydneyAustralia
  2. 2.Sahlgrenska Academy, Institute of Medicine, Department of Public Health and Community MedicineUnit of Social Medicine, University of GothenburgGöteborgSweden
  3. 3.Research and DevelopmentApoteket ABHelsingborg and StockholmSweden

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