Abstract
BackgroundInadequate drug monitoring of drug therapy after hospital discharge facilitates adverse drug events and preventable hospital readmissions.ObjectiveThis study aimed to analyze the structure and content of drug monitoring advices of a representative sample of discharge letters as a basis for future electronic information systems.MethodsOn 2 days in November 2016, all discharge letters of 3 departments of a university hospital were extracted from the hospital information system. The frequency, content, and structure of drug monitoring advices in discharge letters were investigated and compared with the theoretical monitoring requirements expressed in the corresponding summaries of product characteristics (SmPC). The quality of the drug monitoring advices in the discharge letters was rated with the domains of an adapted systematic instructions for monitoring (SIM) score.ResultsIn total, 154 discharge letters were analyzed containing 1180 brands (240 active pharmaceutical substances), of which 50.42% (595/1180) could theoretically be amended with a monitoring advice according to the SmPC. In reality, 40 discharge letters (26.0%, 40/154) contained a total of 66 monitoring advices for 57 brands (4.83%, 57/1180), comprising 18 different monitoring parameters. Drug monitoring advices only addressed mean 1.9 (SD 0.8) of the 7 domains of the SIM score and frequently did not address reasons for monitoring (86%, 57/66), the timing of monitoring, that is, the start (76%, 50/66), the frequency (94%, 63/66), the stop (95%, 63/66), and how to react (83%, 55/66).ConclusionsDrug monitoring advices were mostly absent in discharge letters and a gold standard for appropriate drug monitoring advices was lacking. Hence, more effort should be put in the development of tools that facilitate easy presentation of clinically meaningful drug monitoring advices at the point of care.
Highlights
BackgroundAdverse drug events (ADE) frequently occur after the patient transitions across interfaces of care, making patients prone to unintended outcomes such as hospital readmissions [1,2]
As a first step to develop and subsequently provide suitable drug monitoring advices at interfaces of care, we performed an exploratory analysis of the structure and the patterns of current drug monitoring advices in discharge letters and compared this information with the statutory information provided in the pertinent summary of product characteristics (SmPC)
The discharge letters contained 1180 brands referring to 240 different active pharmaceutical substances from 51 different 3-digit anatomical therapeutic chemical code (ATC) groups, resulting in an average of 7.7 (SD 4.3) brands per discharge letter
Summary
Adverse drug events (ADE) frequently occur after the patient transitions across interfaces of care, making patients prone to unintended outcomes such as hospital readmissions [1,2]. After hospital discharge, monitoring of safety (ADE) and efficacy is often lacking, causing potentially preventable readmissions [10]. Inadequate drug monitoring of drug therapy after hospital discharge facilitates adverse drug events and preventable hospital readmissions. The frequency, content, and structure of drug monitoring advices in discharge letters were investigated and compared with the theoretical monitoring requirements expressed in the corresponding summaries of product characteristics (SmPC). Results: In total, 154 discharge letters were analyzed containing 1180 brands (240 active pharmaceutical substances), of which 50.42% (595/1180) could theoretically be amended with a monitoring advice according to the SmPC. More effort should be put in the development of tools that facilitate easy presentation of clinically meaningful drug monitoring advices at the point of care
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