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A recent study published in the Archives of Internal Medicine looked at the frequency of medication-related hospital admissions and the risk factors for those that are potentially preventable. Although there have been many studies in this area, this particular one looked at all unplanned admissions (almost 13,000) to 21 hospitals in the Netherlands.
What is the background to this?
Of the admissions screened, the authors found that 714 (5.6%) were medicines-related and almost half of these (46.5%) were potentially preventable. Common reasons for hospitalisation of the potentially preventable cases included gastrointestinal tract problems; cardiovascular symptoms; respiratory symptoms; and poor glycaemic control.
Medicines most frequently associated with the potentially preventable admissions included those affecting blood coagulation, NSAIDs, and antidiabetic drugs, with a total of 509 medication errors being identified in the 332 potentially preventable medicines-related admissions.
Risk factors identified by the study included impaired cognition, 4 or more comorbidities, dependant living situation, impaired renal function before hospital admission, and non-adherence to medication regimes. Polypharmacy was also associated with medicines-related hospital admissions.
Summary
The authors made several recommendations, based on their findings. As well as some medication-specific action these included regular review of the use of medicines in high-risk patients (e.g. elderly with polypharmacy) and the exchange of more information relevant to adequate medication surveillance such as co-morbidities and clinical lab data. The authors also recommend the development of information technology to provide information necessary for medication assessment and evaluation and to document changes and reasons for changes to medication.
How does this relate to other publications or evidence?
The recommendations made by the authors link to advice and recommendations suggested in the following documents and information available from NPC:
- Medicines Reconciliation: a guide to implementation
- A Guide to Medication Review 2008
- Medicines Management in LTCs (NPC section)
Action
Prescribers and healthcare professionals should view this study and consider their own medicines management procedures when caring for patients at risk of medicines-related hospital admission.