Abstract
BackgroundAdverse drug reactions, poor patient adherence and errors, here collectively referred to as medication-related harm (MRH), cause around 2.7-8.0% of UK hospital admissions. Communication gaps between successive healthcare providers exist, but little is known about how MRH is recorded in inpatients’ medical records. We describe the presence and quality of MRH documentation for patients admitted to a London teaching hospital due to MRH. Additionally, the international classification of disease 10th revision (ICD-10) codes attributed to confirmed MRH-related admissions were studied to explore appropriateness of their use to identify these patients.MethodsClinical pharmacists working on an admissions ward in a UK hospital identified patients admitted due to suspected MRH. Six different data sources in each patient’s medical record, including the discharge summary, were subsequently examined for MRH-related information. Each data source was examined for statements describing the MRH: symptom and diagnosis, identification of the causative agent, and a statement of the action taken or considered. Statements were categorised as ‘explicit’ if unambiguous or ‘implicit’ if open to interpretation. ICD-10 codes attributed to confirmed MRH cases were recorded.ResultsEighty-four patients were identified over 141 data collection days; 75 met our inclusion criteria. MRH documentation was generally present (855 of 1307 statements were identified; 65%), and usually explicit (705 of 855; 82%). The causative agent had the lowest proportion of explicit statements (139 of 201 statements were explicit; 69%). For two (3%) discharged patients, the causal agent was documented in their paper medical record but not on the discharge summary. Of 64 patients with a confirmed MRH diagnosis at discharge, only six (9%) had a MRH-related ICD-10 code.ConclusionsAvailability of information in the paper medical record needs improving and communication of MRH-related information could be enhanced by using explicit statements and documenting reasons for changing medications. ICD-10 codes underestimate the true occurrence of MRH.
Highlights
Adverse drug reactions, poor patient adherence and errors, here collectively referred to as medication-related harm (MRH), cause around 2.7-8.0% of UK hospital admissions
We report on 1) which aspects of MRH were recorded within patients’ medical records and where; 2) what information relating to the MRH and the causal medicines was communicated back to the General Practitioner (GP) via the hospital discharge communication; 3) how the quantity and quality of information changed throughout the patient’s admission, and 4) which International Classification of Diseases (ICD-10) codes were attributed to MRH-related admissions
MRH types and drugs implicated in admissions The types of MRH suspected as causing admission are categorised in Table 2; 95 different drugs were implicated in the 64 MRH-related admissions
Summary
Poor patient adherence and errors, here collectively referred to as medication-related harm (MRH), cause around 2.7-8.0% of UK hospital admissions. Using medical record review, ADRs and adherence problems [4,5,6] and ADRs exclusively [7,8] have been shown to contribute to 2.78.0% of admissions to UK hospitals [4,5,6,7,8] These figures are comparable to a recent international systematic review [9] which concluded that 5.8% of admissions are caused by ADRs. The estimated cost of ADRs to the National Health Service (NHS) in England is £466 m annually [7]. Harm due to poor adherence, and harm due to medication errors have been identified as contributing to hospital admissions both in the UK and internationally [4,10]
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