Medication safety challenges following hospital discharge: An exploratory analysis of incidents reported in England and Wales over a 5-year period

Introduction: Improving medication-related patient safety during transitions between care settings is one of three international priorities for the World Health Organization's (WHOs) Global Patient Safety Challenge: Medication without harm1. Medication-related incidents and associated harm are common after hospital discharge. A recent systematic review found that one in two adult and elderly patients may be affected by medication errors and one in five experienced adverse drug events after hospital discharge2. Whilst a previous study explored the nature and causes of all types of harmful incidents following hospital discharge in England and Wales using incident report analysis,3 an in-depth evaluation of the nature of medication-related incidents occurring after hospital discharge is urgently needed.
Aim: To characterise the nature of medication-related patient safety incidents occurring following transition of care from hospital to community settings in England and Wales.
Method: A retrospective analysis was conducted of all medication–related incidents reported to the National Reporting and Learning System (NRLS) between 1st January 2015 and 31st December 2019 that were related to the transition from secondary to primary care. All incident reports were anonymised and extracted by the National Patient Safety Team at NHS England and NHS Improvement before being reviewed by the research team. Descriptive analysis was applied to describe the frequency and nature of incidents including the stage of the medication process the incidents occurred (e.g. prescribing, dispensing), the age group of patients involved, class of medication(s) involved, and reported severity of incidents. A data sharing agreement between the University of Manchester and the National Patient Safety Team was established to carry out the study.
Results: Of 1,324 medication-related incident reports, 203 were subsequently excluded due to being not related to medication, or hospital discharge, leaving 1,121 reports for further analysis. Most incidents involved patients aged above 65 years (55%, n=626/1,121). Medication incidents occurred most frequently in the prescribing (42%, n=479) followed by the administration stage (22.5%, n=253). The most reported medication error categories were wrong or unclear dose or strength (19%, n=212), followed by omitted medicine (13%, n=148). Almost one-third of reported incidents were associated with patient harm (low harm (19%, n=215), moderate harm (10.7%, n=120), severe harm (1%, n=14), and death (0.5%, n=6)). The most common medication classes associated with post hospital discharge incident were medications for the cardiovascular system (n=734), central nervous system (n=273), and endocrine system (n=183). The most common medication subgroups associated with incidents were antiplatelets (n=126) followed by factor Xa inhibitors (n=124) and opioids (n=79).
Conclusion: Almost one third of reported medication incidents after hospital discharge were associated with patient harm. Medication incidents occurred most frequently in the prescribing stage, with wrong/unclear dose being the most frequent category, and medication for the cardiovascular system being the most common medication class. Several targets were identified for future research that could support the development of remedial interventions.
References:1. World Health Organization. Global patient safety challenge: medication without harm. 2017; pp. 1–16. http://apps.who.int/iris/bitstream/10665/255263/1/WHO-HIS-SDS-2017.6-eng.pdf?ua=1&ua=1. Accessed September 20, 2020.2. 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 Mar 3:1-21.3. Williams H, Edwards A, Hibbert P, et al. (2015). Harms from discharge to primary care: mixed methods analysis of incident reports. British Journal of General Practice. e829-e837.