Prevalence and nature of medication errors and medication related harm immediately following hospital discharge from hospital to community settings: A systematic review

Background: The immediate time period post hospital discharge may be associated with important risks to patient safety. Drug safety problems may occur at or following discharge such as communication issues and medication changes which might manifest into safety risks in the community such as medication errors (MEs) and related harm1,2. Whilst some evidence exists relating to these safety risks at the point of hospital discharge, there is comparatively little known about their burden and nature in the immediate post‐discharge period in the community.
Aim: Systematically identify and evaluate the available international evidence on the prevalence and nature of medication errors and medication related harm immediately following transition of care from hospital to community settings.
Methods: The search was carried out between the dates January 1990 and September 2018, using the grey literature and 10 databases, including; MEDLINE, EMBASE, CINAHL, PsycINFO, International Pharmaceutical Abstracts, Health Management Information Consortium, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, Database of Abstracts of Reviews of
Effects, and Web of Science. No restrictions were applied on study language, country, or population. Reference lists of included studies and relevant review articles were also searched to identify relevant citations. Studies were excluded if they focused on single drug, drug class, or disease. Data from each study were extracted independently
by two reviewers. Quality assessment of the included studies was completed using a validated framework 3.
Results: Sixty‐nine studies met the inclusion criteria. Sixteen studies (23%) reported MEs rates, nineteen studies (27.9%) reported rates of unintentional medication discrepancies, twenty‐one studies (30.4%) reported adverse drug reactions rates, and twenty‐four studies (34.7%) reported rates of adverse drug events (ADEs). A total of
30 (43.4%) studies originated from the in the United States, and 54 (78%); were published from the year 2010 onwards. Twenty‐two (32%) studies data about severity of identified outcome measures. The median rate of ADEs was found to be 18.8% (Inter Quartile Range [IQR] 14‐29) (n = 23) and the median rate for MEs was found to be 33% (IQR 19‐52) (n = 14) for adult and elderly patients. Heterogeneity was observed in the included studies in terms of outcome
definitions and data collection methods, which precluded meta-analysis. The most commonly reported medications associated with post hospital discharge ADEs were antibiotics, antidiabetics, analgesic
medications, and cardiovascular drugs.
Conclusion: Medication errors and medication related harm are common immediately following transition of care from secondary to primary care. Standardisation of study design is an important target for future research to reduce heterogeneity. Despite this, a number of important targets were identified for future research that could guide
the development of successful remedial interventions.
REFERENCES
1. Forster A, Murff H, Peterson J, et al. “Adverse drug events occurring following hospital discharge”. J Gen Intern Med. 2005; 20(4): 317–323.
2. Mixon A, Myers A, Leak C, et al. “Characteristics associated with post discharge medication errors”. Mayo Clin Proc 2014; 89(8): 1042–1051.
3. Allan E, and Barker K. “Fundamentals of medication error research”.Am J Hosp Pharm. 1990; 47(3): 555–571