Abstract
AbstractBackgroundAustralian data suggest that one‐fifth of emergency department (ED) presentations are re‐presentations within 28 days of discharge, with early re‐presentations common. The contribution of medication misadventure to re‐presentations has been poorly defined to date, but has been reported previously as medication‐related readmission rates of 23%, of which 90% are considered preventable.AimsThis study identified and categorised medication‐related 28‐day ED re‐presentations after discharge, associated medication‐related problems (MRPs) and differences in demographics between medication‐related and ‐unrelated ED re‐presentations.MethodsA retrospective medical record review was conducted for every third adult 28‐day ED re‐presentation between 1 July and 31 December 2016. Re‐presentations were examined for potential medication‐related causes. The MRPs identified were categorised using causality, contribution and preventability criteria.ResultsOf 631 eligible re‐presentations, 196 were sampled. Re‐presentations were potentially medication related in 41 (21%) cases; in 24 (59%) re‐presentations, preventable MRPs were considered the main cause of re‐presentation. Early medication‐related re‐presentations were common: 49% occurred within 7 days of discharge, and 20% on Day 1. Patients re‐presenting with an MRP were, on average, 10.3 years older and prescribed 3.4 more medications on the index discharge than those re‐presenting with a non‐MRP. Cardiovascular medications (n = 14) were most commonly implicated in MRPs, with toxicity or adverse reaction (n = 16) and undertreated (n = 15) the most common MRP categories.ConclusionsOne‐fifth of the 28‐day ED re‐presentations observed were considered potentially medication related, with 59% of these associated with MRPs considered preventable. MRPs most frequently involved cardiovascular medications, adverse reactions and undertreatment. Early individualised pharmaceutical review after discharge may help reduce the MRPs observed.
Published Version
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