Adverse Drug Events After Hospital Discharge in Older Adults
Objectives To characterize adverse drug events (ADEs) occurring within the high-risk 45-day period after hospitalization in older adults.
Design Clinical pharmacists reviewed the ambulatory records of 1,000 consecutive discharges.
Setting A large multispecialty group practice closely aligned with a Massachusetts-based health plan.
Participants Hospitalized individuals aged 65 and older discharged home.
Measurements Possible drug-related incidents occurring during the 45-day period after hospitalization were identified and presented to a pair of physician-reviewers who classified incidents as to whether an ADE was present, whether the event was preventable, and the severity of the event. Medications implicated in ADEs were further characterized according to their inclusion in the 2012 Beers Criteria for Potentially Inappropriate Medication Use in Older Adults.
Results At least one ADE was identified during the 45-day period in 18.7% (n = 187) of the 1,000 discharges. Of the 242 ADEs identified, 35% (n = 84) were deemed preventable, of which 32% (n = 27) were characterized as serious, and 5% (n = 4) as life threatening. More than half of all ADEs occurred within the first 14 days after hospitalization. The percentage of ADEs in which Beers Criteria medications were implicated was 16.5% (n = 40). Beers criteria medications with both a high quality of evidence and strong strength of recommendation were implicated in 6.6% (n = 16) of the ADEs.
Conclusion ADEs are common and often preventable in older adults after hospital discharge, underscoring the need to address medication safety during this high-risk period in this vulnerable population. Beers criteria medications played a small role in these events, suggesting that efforts to improve the quality and safety of medication use during this critical transition period must extend beyond a singular focus on Beers criteria medications.
Adverse drug events (ADEs), especially those that may be preventable, pose a serious concern in older adults during the immediate posthospitalization period. This is a high-risk time for older adults, when multiple medication changes occur that can lead to confusion regarding medication management for patients and providers. One study of older hospitalized adults found that 40% of all admission medications were discontinued by discharge and that 5% of all discharge medications had been newly started during the hospitalization. It has been estimated that 12% to 17% of general medical patients experience ADEs after hospital discharge, a large percentage of which may be preventable.
Multiple factors may contribute to suboptimal medication management after hospital discharge, including poor physician–patient communication and inadequate education regarding medication use, poor therapeutic monitoring, and incomplete or inaccurate information transfer between clinicians. During the immediate posthospital discharge period, individuals may receive medications from different prescribers, who may lack access to comprehensive reconciled medication information. In addition, lack of prompt follow-up care after a hospitalization may exacerbate problems during this particularly high-risk period.
The purpose of this study was to characterize the frequency, preventability, and severity of ADEs occurring during the 45-day posthospitalization period in older adults discharged from hospital to home. Medications implicated in ADEs were further characterized according to their inclusion in the 2012 Beers Criteria for Potentially Inappropriate Medication Use in Older Adults.
Abstract and Introduction
Abstract
Objectives To characterize adverse drug events (ADEs) occurring within the high-risk 45-day period after hospitalization in older adults.
Design Clinical pharmacists reviewed the ambulatory records of 1,000 consecutive discharges.
Setting A large multispecialty group practice closely aligned with a Massachusetts-based health plan.
Participants Hospitalized individuals aged 65 and older discharged home.
Measurements Possible drug-related incidents occurring during the 45-day period after hospitalization were identified and presented to a pair of physician-reviewers who classified incidents as to whether an ADE was present, whether the event was preventable, and the severity of the event. Medications implicated in ADEs were further characterized according to their inclusion in the 2012 Beers Criteria for Potentially Inappropriate Medication Use in Older Adults.
Results At least one ADE was identified during the 45-day period in 18.7% (n = 187) of the 1,000 discharges. Of the 242 ADEs identified, 35% (n = 84) were deemed preventable, of which 32% (n = 27) were characterized as serious, and 5% (n = 4) as life threatening. More than half of all ADEs occurred within the first 14 days after hospitalization. The percentage of ADEs in which Beers Criteria medications were implicated was 16.5% (n = 40). Beers criteria medications with both a high quality of evidence and strong strength of recommendation were implicated in 6.6% (n = 16) of the ADEs.
Conclusion ADEs are common and often preventable in older adults after hospital discharge, underscoring the need to address medication safety during this high-risk period in this vulnerable population. Beers criteria medications played a small role in these events, suggesting that efforts to improve the quality and safety of medication use during this critical transition period must extend beyond a singular focus on Beers criteria medications.
Introduction
Adverse drug events (ADEs), especially those that may be preventable, pose a serious concern in older adults during the immediate posthospitalization period. This is a high-risk time for older adults, when multiple medication changes occur that can lead to confusion regarding medication management for patients and providers. One study of older hospitalized adults found that 40% of all admission medications were discontinued by discharge and that 5% of all discharge medications had been newly started during the hospitalization. It has been estimated that 12% to 17% of general medical patients experience ADEs after hospital discharge, a large percentage of which may be preventable.
Multiple factors may contribute to suboptimal medication management after hospital discharge, including poor physician–patient communication and inadequate education regarding medication use, poor therapeutic monitoring, and incomplete or inaccurate information transfer between clinicians. During the immediate posthospital discharge period, individuals may receive medications from different prescribers, who may lack access to comprehensive reconciled medication information. In addition, lack of prompt follow-up care after a hospitalization may exacerbate problems during this particularly high-risk period.
The purpose of this study was to characterize the frequency, preventability, and severity of ADEs occurring during the 45-day posthospitalization period in older adults discharged from hospital to home. Medications implicated in ADEs were further characterized according to their inclusion in the 2012 Beers Criteria for Potentially Inappropriate Medication Use in Older Adults.
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