Medication-related Admissions Research Articles

Characteristics and preventability of medication-related admissions for acute kidney injury and dehydration in elderly patients

PurposePatients with impaired renal function using medication that affects glomerular filtration rate are at increased risk of developing acute kidney injury (AKI) leading to hospital admissions. The risk increases during periods of dehydration due to diarrhoea, vomiting or fever (so-called “sick days”), or high environmental temperatures (heat wave). This study aims to gain insight into the characteristics and preventability of medication-related admissions for AKI and dehydration in elderly patients.MethodsRetrospective case series study in patients aged ≥ 65 years with admission for acute kidney injury, dehydration or electrolyte imbalance related to dehydration that was defined as medication-related. General practitioner’s (GP) patient records including medication history and hospital discharge letters were available. For each admission, patient and admission characteristics were collected to review the patient journey. A case-by-case assessment of preventability of hospital admissions was performed.ResultsIn total, 75 admissions were included. Most prevalent comorbidities were hypertension, diabetes, and known impaired renal function. Diuretics and RAS-inhibitors were the most prevalent medication combination. Eighty percent of patients experienced non-acute onset of symptoms and 60% had contacted their GP within 2 weeks prior to admission. Around 40% (n = 29) of admissions were considered potentially preventable if pharmacotherapy had been timely and adequately adjusted.ConclusionA substantial proportion of patients admitted with AKI or dehydration experience non-acute onset of symptoms and had contacted their GP within 2 weeks prior to admission. Timely adjusting of medication in these patients could have potentially prevented a considerable number of admissions.

Validation d’une version française de l’outil AT-HARM10 pour la détection des hospitalisations liées au médicament

Admissions of the elderly related to medication errors are frequent in hospital, more than half would be avoidable, but there is currently no validated method in French to identify them. The objective of this work was to validate the French version of the AT-HARM10tool in order to use it for patients admitted in our healthcare facilities. The tool has 10questions. A positive response to any of the first 3questions identify admissions that are unlikely to be drug-related. A positive response to one of the following 7questions identify possible medication-related admissions. For semantic and linguistic validation, we performed cross-validation with forward-backward translation. To clinically validate the method, we conducted a retrospective study including patients over 65admitted to short-stay units (UHCD) and to orthopedic surgery units in two French hospitals. Two hundred and sixty-six (266) patients were included; 166patients admitted to UHCD (mean age 86.0±5.7years; sex ratio 0.66; mean number of drugs prescribed 7.7±3.8) and 100patients admitted to orthopedic units (mean age 85.2±6.1years; sex ratio 0.43; mean number of prescribed drugs 6.4±3.6). We identified 55% of admissions probably related to medication in UHCD and 76% in orthopedic units (p<0.05). The most represented item was P5in both groups (Might [side] effects of the medications the patient was taking [prescribed or not prescribed] prior to hospitalization have caused the admission [including over-treatment]? The validated AT-HARM10tool is now integrated into our clinical pharmacy practices and medication reviews are offered as a priority to patients admitted for iatrogenic reasons.

290 Documenting medication-related needs of older persons assessed by frailty at the front door teams

Abstract Background Older persons presenting with frailty syndromes, polypharmacy and significant comorbidities to Emergency Departments (ED) have a higher rate of adverse outcomes. The aim of this study was to describe medication related needs of persons over 65 years seen by a Frailty at the Front Door (FFD) team in ED. Methods CGAs were performed by an inter-disciplinary team (IDT) between January–December 2022, and included a pharmacy prioritisation toolkit, collecting data including excessive polypharmacy, use of high-risk medications, specific patient or carer medication concerns, fall or medication-related admission and kidney injury. Age, gender, CFS, pharmacy toolkit triggers and specialist Geriatrician review were entered onto Excel and analysed using descriptive statistics. Results 529 CGAs were included. 60 were excluded due to incomplete data (n = 57) or aged under 65 years (n = 3). Mean (SD) age 82.9 (7.9) years. Female:Male ratio 1.5:1. Mean (SD) CFS = 5.2 (1.1). 25% (n = 131) had a fall or medication-related admission. 20% (n = 109) had an acute kidney injury (AKI) or chronic kidney disease (CKD). 26% (n = 141) had excessive polypharmacy. 53% (n = 284) were on one or more high risk medications. 9% (n = 50) had a specific medication concern. 46% (n = 246) triggered for pharmacy review. 72% (n = 178) required specialist geriatrician review. Conclusion Use of high risk medications, excessive polypharmacy and medication or fall related admission are the most common reasons for pharmacy review. Specialist geriatrician review is needed in the majority of cases to assess medication-associated risk and effectively deprescribe. There is a need to develop pathways of care that allow for pharmacy and Geriatrician review of approximately half of older persons seen by an FFD.

509 Developing a Core Outcome Set for hospital deprescribing trials with older people under the care of a geriatrician

Abstract Introduction Half of older people are prescribed unnecessary or harmful medication that are not routinely deprescribed in hospital. There is a need for trials of deprescribing interventions, and for these to adopt consistent measurement and reporting of outcomes(1). Aim To develop a Core Outcome Set (COS) for use in hospital deprescribing trials for older people under the care of a geriatrician. Methods We developed a list of potentially relevant outcomes from the literature. We sought representation from four stakeholder groups: older people and carers, hospital clinicians, hospital managers, and ageing/deprescribing researchers. A gatekeeper at 15 hospitals in England identified and provided study information to hospital staff by email; and older people taking ≥5 medicines, and their carers received printed study information. Academics were recruited worldwide. The number approached was not captured. Using a two-round Delphi survey of participants from all four stakeholder groups scored , each outcome according to Grading of Recommendations Assessment, Development and Evaluation (GRADE)(2). This was followed by two consensus workshops to finalise the COS by discussing the importance, feasibility and acceptability of outcomes. Results In the Delphi survey, 200 people completed Round 1 and 114 completed Round 2. Representing all stakeholder groups, 10 people participated in Workshop 1 and 10 people in Workshop 2. Six outcomes were identified as most important, feasible and acceptable to collect in a trial and were included in the COS for hospital deprescribing trials with older people under the care of a geriatrician. These outcomes were: number of prescribed medicines stopped; number of prescribed medicines with dosage reduced; quality of life; mortality; adverse drug events and number of hospital stays. Three other outcomes were identified as important, but not currently feasible to collect: number of potentially inappropriate medicines prescribed; burden to the patient from their medication; and medication-related admissions to hospital. Conclusion The COS provides the minimum outcomes that should be collected and reported in all hospital deprescribing trials for older people under the care of a geriatrician. This COS builds on three existing COS for: medication reviews in older people with polypharmacy; addressing polypharmacy in older people in primary care; and optimising prescribing in older people in nursing homes. However, it is important when developing a COS to involve all relevant stakeholders that will be affected by a COS, which in this case was older people under the care of a geriatrician and relevant hospital staff. The six outcomes in the COS were agreed as being the most important to be implemented in all hospital deprescribing trials for older people under the care of a geriatrician. The value of considering the feasibility of outcome data collection is demonstrated by the removal of three outcomes that may have compromised COS uptake. Adoption of the COS by hospital deprescribing trials for older people under the care of a geriatrician will enable results from trials to be compared and also allow future aggregation of trial data.

Medication-Related Acute Care Admission and Inappropriate Polypharmacy of Nursing Home Residents.

To evaluate the prevalence of medication-related admissions (MRAs) and their association with potentially inappropriate medications (PIMs) used by nursing home residents admitted to the geriatric center of a tertiary hospital. Cross-sectional study. Older patients admitted from nursing homes to the geriatric center of the Seoul National University Bundang Hospital who had undergone comprehensive geriatric assessment from January 1, 2016, to December 31,2020. MRAs were determined and verified using a previously described MRA adjudication guide. The PIMs in the preadmission medication lists were identified according to each of the following criteria (as well as the combined criteria), the Beers, NORGEP-NH, STOPP/START-NH, and STOPPFrail criteria. Medication use factors associated with MRAs were analyzed using multivariate logistic regression. Among the 304 acute care admissions, 32.2% were MRAs. The main cause of MRAs was acute kidney injury related with use of renin-angiotensin system inhibitors. Approximately 81% of the patients used at least 1 PIM according to the combined criteria. The use of 1 or more PIMs, renin-angiotensin system inhibitors, diuretics, nonsteroidal anti-inflammatory drugs, and benzodiazepines was significantly associated with MRAs. The combined criteria were able to predict MRAs better than the individual criteria. Approximately one-third of acute admissions of nursing home residents may be MRAs. Interventions for the optimal use of medication among nursing home residents are needed.

Developing a core outcome set for hospital deprescribing trials for older people under the care of a geriatrician.

Half of older people are prescribed unnecessary/inappropriate medications that are not routinely deprescribed in hospital hence there is a need for deprescribing trials. We aimed to develop a Core Outcome Set (COS) for deprescribing trials for older people under the care of a geriatrician during hospital admission. We developed a list of potentially relevant outcomes from the literature. Using a two-round Delphi survey of stakeholder groups representing older people and carers, hospital clinicians, hospital managers, and ageing/deprescribing researchers, each outcome was scored according to Grading of Recommendations Assessment, Development and Evaluation, followed by two consensus workshops to finalise the COS. Two hundred people completed Round 1 and 114 completed Round 2. Representing all stakeholder groups, 10 people participated in workshop 1 and 10 in workshop 2. Six outcomes were identified as most important, feasible and acceptable to collect in a trial: number of prescribed medicines stopped; number of prescribed medicines with dosage reduced; quality of life; mortality; adverse drug events and number of hospital stays. Three other outcomes were identified as important, but currently too burdensome to collect: number of potentially inappropriate medicines prescribed; burden from medication routine; and medication-related admissions to hospital. A COS represents the minimum outcomes that should be collected and reported. Whilst uncommon practice for COS development, the value of considering outcome collection feasibility is demonstrated by the removal of three potential outcomes that, if included, may have compromised COS uptake due to challenges with collecting the data.

Additional value of a triggerlist as selection criterion in identifying patients at high risk of medication-related hospital admission: a retrospective cohort study.

Of all hospital admissions in older patients, 10-30% seem to be medication-related. However, medication-related admissions are often unidentified in clinical practice. To increase the identification of medication-related hospital admissions in older patients a triggerlist is published in the Dutch guideline for polypharmacy. To assess whether the triggerlist has value as selection criterion to identify patients at high risk of medication-related hospital admissions. This retrospective cohort study was carried out in 100 older (≥ 60years) patients with polypharmacy and having two triggers from the triggerlist. The admissions were assessed as either possibly or unlikely medication-related according to the Assessment Tool for identifying Hospital Admissions Related to Medications. Of all the admissions 48% were classified as possibly medication-related. Patients with a possible medication-related hospital admission were more likely to have an impaired renal function (p = 0.015), but no differences with regard to age, sex, comorbidity or number of medicines were found. The high prevalence of medication-related hospital admissions, suggests the triggerlist may have added value as selection criterion in a cohort of older patients with polypharmacy and can be used to improve the identification of a population at high risk of medication-related hospital admissions.

Control in the Hospital by Extensive Clinical rules for Unplanned hospitalizations in older Patients (CHECkUP); study design of a multicentre randomized study

BackgroundDue to ageing of the population the incidence of multimorbidity and polypharmacy is rising. Polypharmacy is a risk factor for medication-related (re)admission and therefore places a significant burden on the healthcare system. The reported incidence of medication-related (re)admissions varies widely due to the lack of a clear definition. Some medications are known to increase the risk for medication-related admission and are therefore published in the triggerlist of the Dutch guideline for Polypharmacy in older patients. Different interventions to support medication optimization have been studied to reduce medication-related (re)admissions. However, the optimal template of medication optimization is still unknown, which contributes to the large heterogeneity of their effect on hospital readmissions. Therefore, we implemented a clinical decision support system (CDSS) to optimize medication lists and investigate whether continuous use of a CDSS reduces the number of hospital readmissions in older patients, who previously have had an unplanned probably medication-related hospitalization.MethodsThe CHECkUP study is a multicentre randomized study in older (≥60 years) patients with an unplanned hospitalization, polypharmacy (≥5 medications) and using at least two medications from the triggerlist, from Zuyderland Medical Centre and Maastricht University Medical Centre+ in the Netherlands. Patients will be randomized. The intervention consists of continuous (weekly) use of a CDSS, which generates a Medication Optimization Profile, which will be sent to the patient’s general practitioner and pharmacist. The control group will receive standard care. The primary outcome is hospital readmission within 1 year after study inclusion. Secondary outcomes are one-year mortality, number of emergency department visits, nursing home admissions, time to hospital readmissions and we will evaluate the quality of life and socio-economic status.DiscussionThis study is expected to add evidence on the knowledge of medication optimization and whether use of a continuous CDSS ameliorates the risk of adverse outcomes in older patients, already at an increased risk of medication-related (re)admission. To our knowledge, this is the first large study, providing one-year follow-up data and reporting not only on quality of care indicators, but also on quality-of-life.Trial registrationThe trial was registered in the Netherlands Trial Register on October 14, 2018, identifier: NL7449 (NTR7691). https://www.trialregister.nl/trial/7449.

Medication Discrepancies and Regimen Complexity in Decompensated Cirrhosis: Implications for Medication Safety.

Discrepancies between the medicines consumed by patients and those documented in the medical record can affect medication safety. We aimed to characterize medication discrepancies and medication regimen complexity over time in a cohort of outpatients with decompensated cirrhosis, and evaluate the impact of pharmacist-led intervention on discrepancies and patient outcomes. In a randomized-controlled trial (n = 57 intervention and n = 57 usual care participants), medication reconciliation and patient-oriented education delivered over a six-month period was associated with a 45% reduction in the incidence rate of ‘high’ risk discrepancies (IRR = 0.55, 95%CI = 0.31–0.96) compared to usual care. For each additional ‘high’ risk discrepancy at baseline, the odds of having ≥ 1 unplanned medication-related admission during a 12-month follow-up period increased by 25% (adj-OR = 1.25, 95%CI = 0.97–1.63) independently of the Child–Pugh score and a history of variceal bleeding. Among participants with complete follow-up, intervention patients were 3-fold less likely to have an unplanned medication-related admission (adj-OR = 0.27, 95%CI = 0.07–0.97) compared to usual care. There was no association between medication discrepancies and mortality. Medication regimen complexity, frequent changes to the regimen and hepatic encephalopathy were associated with discrepancies. Medication reconciliation may improve medication safety by facilitating communication between patients and clinicians about ‘current’ therapies and identifying potentially inappropriate medicines that may lead to harm.

Predictors of Medication-Related Emergency Department Admissions Among Patients with Cardiovascular Diseases at Mbarara Regional Referral Hospital, South-Western Uganda.

BackgroundMedication-related emergency department admissions impose a huge and unnecessary burden on the healthcare system. We sought to determine the prevalence and predictors of medication-related emergency department admissions, among patients with cardiovascular diseases at Mbarara Regional Referral Hospital, Uganda.MethodsInstitutional research ethics approval was secured to conduct a cross-sectional study at the Mbarara Regional Referral Hospital emergency department, between February and September, 2020. All eligible and consenting patients were enrolled in a consecutive manner after a preliminary diagnosis was made by the attending physician. Structured questionnaire interview and comprehensive medication history reviews were used to identify medication therapy problems, in collaboration with a resident physician present on duty. We used sequential categorization for medication therapy problem(s). Descriptive and logistic regression analyses were used to determine prevalence and predictors of medication-related emergency department admissions.ResultsOut of the 128 patients interviewed, 105 (82%) patient admissions were associated with a medication therapy problem: ineffectiveness of drug therapy (53.3%, 56), medication non-adherence (42.9%, 45), and adverse drug reactions (3.8%, 4). Out of a total of 90 incidences of medication non-adherence, 34.4% (31/90) were due to lack of understanding of patient medication regimen, and 27.8% (25/90) due to unaffordable cost of medicines. Female gender (AOR = 4.31 [1.43, 13.03 at 95% CI]; P-value = 0.010]) and a history of tobacco use (AOR = 9.58 [1.14, 80.28 at 95% CI]; P-value = 0.037) were statistically significant predictors of medication-related emergency department admissions in adjusted analysis.ConclusionFour in five emergency department admissions were associated with medication-related causes, majorly due to ineffectiveness of drug therapy. Knowledge gap on patient medication regimens was the most prevalent cause for medication non-adherence. Female gender and previous or current tobacco use was an independent risk factor for medication-related admissions.

Effects of Hospital-Based Comprehensive Medication Reviews Including Postdischarge Follow-up on Older Patients’ Use of Health Care

Suboptimal use of medications is a leading cause of health care-related harm. Medication reviews improve medication use, but evidence of the possible benefit of inpatient medication review for hard clinical outcomes after discharge is scarce. To study the effects of hospital-based comprehensive medication reviews (CMRs), including postdischarge follow-up of older patients' use of health care resources, compared with only hospital-based reviews and usual care. The Medication Reviews Bridging Healthcare trial is a cluster randomized crossover trial that was conducted in 8 wards with multiprofessional teams at 4 hospitals in Sweden from February 6, 2017, to October 19, 2018, with 12 months of follow-up completed December 6, 2019. The study was prespecified in the trial protocol. Outcome assessors were blinded to treatment allocation. In total, 2644 patients aged 65 years or older who had been admitted to 1 of the study wards for at least 1 day were included. Data from the modified intention-to-treat population were analyzed from December 10, 2019, to September 9, 2020. Each ward participated in the trial for 6 consecutive 8-week periods. The wards were randomized to provide 1 of 3 treatments during each period: CMR, CMR plus postdischarge follow-up, and usual care without a clinical pharmacist. The primary outcome measure was the incidence of unplanned hospital visits (admissions plus emergency department visits) within 12 months. Secondary outcomes included medication-related admissions, visits with primary care clinicians, time to first unplanned hospital visit, mortality, and costs of hospital-based care. Of the 2644 participants, 7 withdrew after inclusion, leaving 2637 for analysis (1357 female [51.5%]; median age, 81 [interquartile range, 74-87] years; median number of medications, 9 [interquartile range, 5-13]). In the modified intention-to-treat analysis, 922 patients received CMR, 823 received CMR plus postdischarge follow-up, and 892 received usual care. The crude incidence rate of unplanned hospital visits was 1.77 per patient-year in the total study population. The primary outcome did not differ between the intervention groups and usual care (adjusted rate ratio, 1.04 [95% CI, 0.89-1.22] for CMR and 1.15 [95% CI, 0.98-1.34] for CMR plus postdischarge follow-up). However, CMR plus postdischarge follow-up was associated with an increased incidence of emergency department visits within 12 months (adjusted rate ratio, 1.29; 95% CI, 1.05-1.59) compared with usual care. There were no differences between treatment groups regarding other secondary outcomes. In this study of older hospitalized patients, CMR plus postdischarge follow-up did not decrease the incidence of unplanned hospital visits. The findings do not support the performance of hospital-based CMRs as conducted in this trial. Alternative forms of medication reviews that aim to improve older patients' health outcomes should be considered and subjected to randomized clinical trials. ClinicalTrials.gov Identifier: NCT02986425.

A study on medication-related hospital admissions in a tertiary care hospital

Medication-related hospital admissions have gained attention during the last few decades. It has been reported that up to 5% of all hospital admissions were medication-related and 50 % of those were avoidable. In India, studies on medication-related hospital admissions are still in the infancy stage. The objective of the study was to assess the types and outcomes of medication-related hospital admissions (MRHA) in a tertiary care teaching hospital. This prospective observational study was conducted for six months at JSS Hospital, Mysuru. Patients of any age and gender, who were admitted to General Medicine, Emergency, Nephrology, Psychiatry, Pulmonology wards due to medication-related problems were enrolled in the study after obtaining an Inform Consent Form. All the necessary data about MRPs were collected and documented in a suitably designed data collection form. MRPs were classified by using Hepler and Strand classification, and the implicated drugs were coded by using the Anatomical Therapeutic Chemical Classification system (ATC) code. Prevalence of medication-related admissions was calculated by dividing the total number of medication-related admissions and the total number of admissions to the hospital. There were 185 MRHA during the study period in the respective departments. The total prevalence of MRHA in the included departments was 1.27%. Failure to receive drugs (50.27%) accounted for the maximum MRHA, followed by adverse drug reactions (46.44 %) and overdose (3.27%). The average cost associated with MRHA was found as INR 10,440 (USD-174, £ - 149). The average length of stay of MRHA was found as approximately seven days [6.96, (sd±2.42)]. The study shows that failure to receive drugs leading to hospitalization are frequent and constitute a significant economic burden. Training of patients and prescribers may lead to a reduction in hospitalization due to MRPs and thus lessen their financial burden.

Potentially preventable medication-related hospitalizations: A clinical pharmacist approach to assessment, categorization, and quality improvement

ObjectivesThe primary objective of this report is to describe a quality improvement practice designed to identify and categorize potentially preventable medication-related hospital admissions. The secondary objective is to present data collected from this practice and describe how it was used to improve a pharmacist intervention focused on reducing medication-related readmissions. SettingThis practice was developed as part of the quality improvement system supporting a pharmacist-led care transition model that was implemented across rural and urban counties in Hawaii. Practice descriptionPharmacists systematically assessed readmissions of the high-risk patients who were enrolled in the care transition model to determine the reasons for the admission and whether each was potentially preventable and medication related. This information was then used to improve the care transition model. Practice innovationThis admission categorization system is the first based on best practice in pharmaceutical care and identifies indication, effectiveness, safety, and adherence problems, as well as subcategories within each of those domains. EvaluationThis quality improvement practice was applied to 401 readmissions. A chi-square test was used to determine if there were differences between urban and more rural areas regarding percentage of readmissions that were potentially preventable and medication related. ResultsTwenty-six percent of the readmissions were determined to be potentially preventable and medication related. The most common categories were nonadherence due to patient choice (23.8%), untreated condition for which medication is indicated (13.3%), dose too high (10.5%), and dose too low (10.5%). The percentage of readmissions that were potentially preventable and medication related was significantly higher in more rural areas (30%) compared with urban areas (17%). There were no significant rural–urban differences by major category of potentially preventable medication-related admissions. ConclusionThis systematic and actionable approach to reviewing and categorizing potentially preventable medication-related admissions can facilitate improvement in care and document the value of pharmacists serving in patient care roles.

Hospitalizations Due to Adverse Drug Events in the Elderly-A Retrospective Register Study.

Adverse drug events (ADEs) are more likely to affect geriatric patients due to physiological changes occurring with aging. Even though this is an internationally recognized problem, similar research data in Finland is still lacking. The aim of this study was to determine the number of geriatric medication-related hospitalizations in the Finnish patient population and to discover the potential means of recognizing patients particularly at risk of ADEs. The study was conducted retrospectively from the 2014 emergency department patient records in Oulu University Hospital. A total number of 290 admissions were screened for ADEs, adverse drug reactions (ADRs) and drug-drug interactions (DDIs) by a multi-disciplinary research team. Customized Naranjo scale was used as a control method. All admissions were categorized into “probable,” “possible,” or “doubtful” by both assessment methods. In total, 23.1% of admissions were categorized as “probably” or “possibly” medication-related. Vertigo, falling, and fractures formed the largest group of ADEs. The most common ADEs were related to medicines from N class of the ATC-code system. Age, sex, residence, or specialty did not increase the risk for medication-related admission significantly (min p = 0.077). Polypharmacy was, however, found to increase the risk (OR 3.3; 95% CI, 1.5–6.9; p = 0.01). In conclusion, screening patients for specific demographics or symptoms would not significantly improve the recognition of ADEs. In addition, as ADE detection today is largely based on voluntary reporting systems and retrospective manual tracking of errors, it is evident that more effective methods for ADE detection are needed in the future.

The extent of medication errors and adverse drug reactions throughout the patient journey in acute care in Australia.

To provide an estimate of the numbers of medication errors and adverse drug reactions that occur along a person's journey through their hospital stay in Australia. A search of databases and online resources was undertaken to identify published literature on medication safety in the acute care setting in Australia from 2008 to 2013. Data on the rates of adverse drug reactions and medication errors associated with hospitalization was extracted from the published studies. This evidence was synthesized with evidence from previous reviews of medication safety in the acute care setting in Australia conducted in 2002 and 2008. Findings from the Australian literature across the two previous reviews of medication safety and the present review indicate the proportion of all hospital admissions that are medication-related is between 2 and 3%. Studies assessing medication errors on admission to hospital suggest there may be an overall rate of two errors for every three patients at the time of admission to hospital. Large studies examining the rates of prescribing errors in major Australian teaching hospitals give insight into the rates of prescription error and suggest that prescription error rates of up to one error per patient occur in the hospital system. The best available evidence from more recent research suggests that errors (excluding errors of timing) occur in around 9% of medication administrations in hospital. At hospital discharge, errors in medication documentation in discharge summaries may occur at a rate of up to two errors per patient. Medication safety in the various stages of the patient journey through acute care in Australia continues to be a significant problem. However, the extent of medication-related problems in acute care needs to be interpreted within the context of increasingly complex health care. There are an estimated 230 000 medication-related hospital admissions occurring per year. This suggests an annual cost of medication-related admissions of AU$1.2 billion.

Pharmacist provision of patient medication education groups.

In the United States, medication nonadherence accounts for 10% of all hospital admissions and 33–69% of medication-related admissions, resulting in direct costs of $100–$289 billion annually.[1][1]–[6][2] Inadequate information about medication and a lack of understanding are barriers to

The medication minefield: using computerized decision support systems to reduce preventable adverse drug events and hospitalizations.

Preventable adverse drug events (ADEs) are a source of avoidable hospitalizations, morbidity and mortality, especially among those older than 65 years. Computerized decision support systems (CDSSs) can identify and address ADEs, but relatively little has been written about the effectiveness of such system in the community setting. This article will review some important studies on the causes of medication-related admissions in the ambulatory setting, where a lack of communication among prescribers creates a virtual minefield of medication risk. Some preliminary data will show how the application of CDSSs can affect the outcomes of care, including a reduction in preventable admissions and readmissions.

Medicines management support to older people: understanding the context of systems failure

ObjectivesChanging demographics and pressures on the healthcare system mean that more older people with complex medical problems need to be supported in primary and community care settings. The challenge of...

Medication-Related Admissions in Older People

Medication-related admissions are an important cause of hospital admissions in older people. The scope for prevention is less clear. To characterize medication-related hospital admissions in older people and assess their preventability. This was a cross-sectional, observational study conducted over 3 months. A pharmacist based in the medical admissions ward of a north London hospital screened all patients aged > or =65 years. A specialist physician assembled additional information, which was presented to a multi-professional panel to confirm attribution and preventability. A total of 409 patients were screened, of whom 14% (95% CI 10.6, 17.4) had medication-related problems, 6.4% (95% CI 4.0, 8.8) were admitted because of medication-related problems and 3.9% (95% CI 2.0, 5.8) were considered to have preventable medication-related problems. Medicines to prevent or treat cardiovascular disease were implicated in 69% (18/26) of the medication-related admissions and 69% (11/16) of preventable medication-related admissions. Amongst hospitalized patients, admission attributed to adverse drug reaction was more likely as the number of medications being taken increased, and admission attributed to undertreatment was more likely as the number of pre-existing conditions increased. Medication-related admissions are common in older people and over half are preventable. Morbidity associated with medicines used for cardiovascular disease is important. There is a difficult balance to be struck between avoiding iatrogenic illness in older people and ensuring they benefit from medications for pre-existing conditions. Opportunities exist for improving the delivery of care to reduce adverse outcomes.

Unplanned Medication‐Related Admissions to an Acute Care General Teaching Hospital

To determine the incidence and preventability of unplanned admissions to a State acute care general teaching hospital caused by adverse medication‐related events (AMREs).