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Hospital, ICU Patients at Risk of Medication Disruption Upon Release | Port Orange Medical Malpractice Attorney

Hospital, ICU Patients at Risk of Medication Disruption Upon Release

Discharged hospital patients are at increased risk of unintentional discontinuation of commonly prescribed chronic disease medications, with this risk even greater for patients who were admitted to an intensive care unit, according to a new study.

Dr. Chaim M. Bell, of St. Michael’s Hospital and the Institute for Clinical Evaluative Sciences, Toronto, and colleagues examined the rates of unintended discontinuation of common medications for chronic diseases after acute care hospitalization and ICU admission.

“Transitions in care are vulnerable periods for patients during hospitalization. Medical errors during this period can occur as a result of incomplete or inaccurate communication as responsibility shifts from one physician to another,” the study’s authors write.

“At hospital discharge, patients may be susceptible to prescription errors of omission, including the unintentional discontinuation of medications with proven efficacy for treating chronic diseases. Treatment in the intensive care unit (ICU) may place patients at elevated risk for such errors of omission,” according to the study.

For the study the researchers used administrative records from 1997 to 2009 of all hospitalizations and outpatient prescriptions in Ontario, Canada, which included 396,380 patients who were 66 years or age or older with continuous use of at least 1 of 5 evidence-based medication groups prescribed for long-term use: (1) statins, (2) antiplatelet/anticoagulant agents, (3) levothyroxine (medication for thyroid problems), (4) respiratory inhalers, and (5) gastric acid-suppressing drugs.

Rates of medication discontinuation were compared across 3 groups: patients admitted to the ICU, patients hospitalized without ICU admission, and nonhospitalized patients (controls). The primary outcome measure was a patient’s failure to renew a prescription within 90 days after hospital discharge.

The study included 187,912 hospitalized patients and 208,468 controls. The researchers found that patients admitted to the hospital were more likely to experience potentially unintentional discontinuation of medications than controls across all medication groups examined.

The highest rate of medication discontinuation occurred in the antiplatelet or anticoagulant agent group. In this group, there were 552 patients (22.8 percent) with an ICU admission who discontinued these medications after hospital discharge.

In contrast, of the patients in the control group who were receiving antiplatelet or anticoagulant medications, only 11.8 percent experienced medication discontinuation at 90 days. The respiratory inhaler group had the lowest rate of medication discontinuation (4.5 percent).

The authors also found that there was an increased risk of medication discontinuation in patients with an ICU admission compared with nonhospitalized patients.

“Overall, the increased risk of medication discontinuation in patients with an ICU admission was statistically significant in 4 of the 5 medication groups compared with hospitalized patients without an ICU admission.”

One-year follow-up of patients who discontinued medications showed an elevated risk for the secondary composite outcome of death, emergency department visit, or emergent hospitalization in the statins group and in the antiplatelet/anticoagulant agents group.

“Better communication and a system-based method have been advocated as possible solutions to improve medication continuity and safety,“ Bell said. “These strategies can range from customized integrated hospital computer systems to simple preprinted forms. However, their success is contingent on including all relevant clinicians and the patients themselves.”

For more on medical safety issues, see the library of articles by Daytona Beach medical malpractice attorney.

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