09 Aug Medication Errors and Transitions of Care-Is there Hope?
I will explore some key causes and solutions to medication errors associated with care transitions using components of Hope Street Group’s analytical model: “Amplify” our productivity- Improve the quality and cost of transitions between acute and other types of care.
Care transitions have been identified as points in the health care continuum that can increase risk of medication errors due to poor coordination (California HealthCare Foundation, 2007). Approaches to improving medication errors during care transitions include: checklists, computerized order entry, medication reconciliation, improving the “safety culture” and teamwork (Agency for Healthcare Research and Quality). This post will discuss the overall impact of post-hospital adverse events. Subsequent posts this week, will discuss the feasibility, appropriateness and evidence for the leading potential solutions/interventions based upon a review of the literature.
The overall incidence of post-hospital adverse events has been reported to be 20% within 3 weeks of discharge(Forster, Murff, Peterson, Ganhi, & Bates, 2003). Moreover, the same researchers stated that nearly 75% of those adverse events could have been prevented or ameliorated (Forster, Murff, Peterson, Ganhi, & Bates, 2003). It has also been argued that care transitions are especially important for elderly patients and other high-risk patients who have multiple medications and comorbidities (Halasyamani, et al., 2006). Despite the lack of official numbers, researchers agree that the risk for post-hospital adverse events continues to mount as the elderly and other high-risk patients make the transition to a nursing home(Halasyamani, et al., 2006).
However, a combination of individual, team and organizational issues contribute to the challenges of lowering the risk of medication errors during care transitions to nursing homes and long-term care facilities from hospitals (Table 1).
Challenges of Lowering the Risk of Medication Errors During Care Transitions to Nursing Homes and Long-Term Care Facilities from Hospitals (Northwest Memorial Hospital, 2011)
| Patients and/advocate/family members ability to recall medications, doses and/or frequency of use | Stress of transitioning through the health care system
Language barriers, cultural beliefs |
| Health literacy | Interviewers’ skill level |
| Relationship with the healthcare clinician who is obtaining the history | Time constraints |
| Accuracy and completeness of medication histories obtained form other resources | Accessibility of patents’ medication list during night/weekend hours. |
While the research focus here is between hospitals and nursing homes, lessons can be applied to any situation where there is a transition of care in the health eco-system.
As we look to see if these approaches to improving medication errors during care transitions really help this week, please tell us about your experiences with:
- checklists,
- computerized order entry,
- medication reconciliation,
- improving the “safety culture”/teamwork and;
- shovel ready interventions (i.e. TeamSTEPPS)
California HealthCare Foundation. (2007). Fast Facts: Coordinating Care Transitions. Oakland: California HealthCare Foundation.
Agency for Healthcare Research and Quality. (2011 February). Nursing Home Survey on Patient Safety Culture. Retrieved 2011 14-March from Agency for Healthcare Research and Qulaity: http://www.ahrq.org.gov/qual/patientsafetyculture/nhsurvindex.htm
Forster, A., Murff, H., Peterson, J., Ganhi, T., & Bates, D. (2003). The Incidence and Severity of Adverse Events Affecting Patients after Discharge from the Hospital. Annals of Internal Medicine, 138 (3), 161-167.
Halasyamani, L., Kripalani, S., Coleman, E., Schnipper, J., vanWalraven, C., Nagamine, J., et al. (2006). Transition of Care for Hospitalized Elderly Patients: Development of a Discharge Checklist for Hospitalists. Journal of Hospital Medicine, 1 (6), 354-360.