Medication errors and adverse drug events are common following hospital discharge

Alqenae FA, Steinke D, Keers RN. Prevalence and nature of medication errors and medication-related harm following discharge from hospital to community settings: A systematic review Drug Safety. 2020; 43(6):517-537.

Review question

•      What is the prevalence and nature of medication errors and adverse drug events following transition of care from hospital to community settings?

Background

•      Transitions of care are changes in the level, location, or providers of care as patients move within the health system.

•      While they are intended to be seamless and safe, care transitions are known to place patients at risk of adverse outcomes including medication errors, missed test results and adverse events including hospital readmission.

•      The time period immediately following hospital discharge can be a challenging time for patients, both in terms of safety but also socially and emotionally, when patients may be anxious and suffer from functional impairments.

•      The aim of this systematic review is to explore the prevalence and nature of medication errors and adverse drug events following transition of care from hospital to community settings.

How the review was done

•      Review authors conducted a detailed search of ten research databases for suitable articles to include the review.

•      A grey literature database was also searched for unpublished articles on this topic.

•      Articles were eligible for inclusion if they were published between January 1990 and March 2019.

•      Key search terms included rate, prevalence, hospital discharge, medication error, and adverse drug event.

•      A total of 22,082 articles were retrieved from the initial search, of which 54 were included in this review.

•      The lead author of this review was funded by the Kuwait Civil Service Commission as part of her PhD program. All authors declared no conflicts of interest. 

What the researchers found

•      The 54 studies included in this systematic review spanned 20,895 hospital discharges across 26 countries. Most of the studies were conducted in the United States and the United Kingdom.

•      Among studies reporting on the frequency of medication errors, one study reported that one or more prescribing errors affected 43% of discharged patients, while another study reported that 3.5% of discharge medications were affected by at least one monitoring error post-discharge. Another study reported that 54% of discharged patients were affected by medication errors.

•      In studies examining non-preventable adverse drug events, researchers found that on average, 27% of adult and elderly patients experienced one or more adverse drug events post-hospital discharge. The median adverse drug event rate from studies examining preventable adverse drug events was 19%.

•      Overall, the most common drug classes that were reported to lead to post-discharge adverse drug events were antibiotics, antidiabetics, analgesics, and cardiovascular drugs.

Conclusion

•      This is the first known comprehensive review of the burden and nature of medical errors and medication-related harm following hospital discharge across general populations.

•      Medication errors and adverse drug events were found to be common following hospital discharge, but a detailed comparison between studies was limited because of differences in the design of included studies.