Skip to main content

Medication-related problems during transfer from hospital to home care: baseline data from Switzerland

Abstract

Background The shift from inpatient to ambulatory care has resulted in an increase in home care patients. Little is known regarding medication safety associated with patient transfer from hospital to home care. Objective To evaluate medication-related problems in patients transferring from hospital to home care in Switzerland. Setting A non-for-profit home care organization in the city of Lucerne/Switzerland. Methods We conducted a prospective observational study, including patients aged ≥ 64 years and receiving ≥ 4 medications at hospital discharge. Two structured questionnaires assessing the transfer process were completed by home care nurses. Prescription quality was assessed using a PCNE Type 2b Medication Review. Main outcome measures The quality of the transfer process was measured comparing agreed-upon with reported parameters. Prescription quality was analyzed assessing the unambiguity of the prescription. Potentially inappropriate medications (Priscus® list), contraindications, duplications and interactions, and clinical pharmacist-identified potential medication-related problems were collected. Results Study patients (n = 100) received 8.6 ± 3.5 regularly administered medications. Only 5/100 patients had a complete set of written discharge information. At the time of the first visit, 13/100 patients had no written medication information available. Discharge medication prescriptions were clear to nurses in 62% of patients. In 20 patients, the required medications were unavailable, resulting in 19 medication errors. Assessment by a clinical pharmacist revealed only 33/100 patients had a clear discharge prescription. Of a total of 984 prescribed drugs, 16% were considered to be ambiguous, 22 (2.2%) were potentially inappropriate. 7/984 drugs were contraindicated, 8 were duplicates. Conclusion In addition to the known risk factors in patients transferring from hospital to home care (age, polymedication, multiple providers), 3 major problems impacted upon medication safety: fragmented communication, unreliable medication availability and a poor prescription quality. Clinical pharmacists are an important option to improve medication safety ass.

This is a preview of subscription content, access via your institution.

References

  1. Landrigan CP, Parry GJ, Bones CB, Hackbarth AD, Goldmann DA, Sharek PJ. Temporal trends in rates of patient harm resulting from medical care. N Engl J Med. 2010;363(22):2124–34.

    CAS  Article  Google Scholar 

  2. Kohn LT, Corrigan JM, Donaldson MS. To err is human: building a safer health care system. Washington, DC: National Academic Press; 1999.

    Google Scholar 

  3. Federal Office of Statistics. Scenarios for the demographic development of Switzerland 2015–2045. Neuchatel: Federal Office of Statistics; 2015.

    Google Scholar 

  4. Meyer-Massetti C, Kaiser E, Hedinger-Grogg B, Luterbacher S, Hersberger K. Medication safety in the home care setting: error-prone process steps. Pflege. 2012;25(4):261–9.

    CAS  Article  Google Scholar 

  5. Hofer-Dueckelmann C, Prinz E, Beindl W, Szymanski J, Fellhofer G, Pichler M, et al. Adverse drug reactions (ADRs) associated with hospital admissions—elderly female patients are at highest risk. Int J Clin Pharmacol Ther. 2011;49(10):577–86.

    CAS  Article  Google Scholar 

  6. Krahenbuhl-Melcher A, Schlienger R, Lampert M, Haschke M, Drewe J, Krahenbuhl S. Drug-related problems in hospitals: a review of the recent literature. Drug Saf. 2007;30(5):379–407.

    Article  Google Scholar 

  7. Salvi F, Marchetti A, D’Angelo F, Boemi M, Lattanzio F, Cherubini A. Adverse drug events as a cause of hospitalization in older adults. Drug Saf. 2012;35(Suppl 1):29–45.

    Article  Google Scholar 

  8. Wimmer BC, Cross AJ, Jokanovic N, Wiese MD, George J, Johnell K, et al. Clinical outcomes associated with medication regimen complexity in older people: a systematic review. J Am Geriatr Soc. 2017;65(4):747–53.

    Article  Google Scholar 

  9. Meyer-Massetti C, Meier CR, Guglielmo BJ. The scope of drug-related problems in the home care setting. Int J Clin Pharm. 2018;40(2):324–34. https://doi.org/10.1007/s11096-017-0581-9.

    Article  Google Scholar 

  10. Wong JD, Bajcar JM, Wong GG, Alibhai SM, Huh J-H, Cesta A, et al. Medication reconciliation at hospital discharge: evaluating discrepancies. Ann Pharmacother. 2008;42(10):1373–9.

    Article  Google Scholar 

  11. Garcia-Caballos M, Ramos-Diaz F, Jimenez-Moleon JJ, Bueno-Cavanillas A. Drug-related problems in older people after hospital discharge and interventions to reduce them. Age Ageing. 2010;39(4):430–8.

    Article  Google Scholar 

  12. Bishop MA, Cohen BA, Billings LK, Thomas EV. Reducing errors through discharge medication reconciliation by pharmacy services. Am J Heal Pharm. 2015;72(17_Supplement_2):S120–6.

    Article  Google Scholar 

  13. Mekonnen AB, McLachlan AJ, Brien JE. Effectiveness of pharmacist-led medication reconciliation programmes on clinical outcomes at hospital transitions: a systematic review and meta-analysis. BMJ Open. 2016;6(2):e010003.

    Article  Google Scholar 

  14. Kwan Y, Fernandes OA, Nagge JJ, Wong GG, Huh JH, Hurn DA, et al. Pharmacist medication assessments in a surgical preadmission clinic. Arch Intern Med. 2007;167(10):1034–40.

    Article  Google Scholar 

  15. Spitex Stadt Luzern-Annual report. 2016. www.spitex-luzern.ch. Accessed 28 Sept 2018.

  16. Foundation PCNE. PCNE classification for drug related problems. v8.02. 2003–2017. Available from: https://www.pcne.org/upload/files/230_PCNE_classification_V8-02.pdf. Accessed 28 Sept 2018.

  17. Holt S, Schmiedl S, Thurmann PA. Potentially inappropriate medications in the elderly: the PRISCUS list. Dtsch Arztebl Int. 2010;107(31–32):543–51.

    PubMed  PubMed Central  Google Scholar 

  18. American Geriatrics Society 2015 Updated beers criteria for potentially inappropriate medication use in older adults. J Am Geriatr Soc. 2015;63(11):2227–46. http://doi.org/10.1111/jgs.13702.

  19. Kaufmann CP, Stampfli D, Hersberger KE, Lampert ML. Determination of risk factors for drug-related problems: a multidisciplinary triangulation process. BMJ Open. 2015;5(3):e006376.

    Article  Google Scholar 

  20. Kattel S, Manning DM, Erwin PJ, Wood H, Kashiwagi DT, Murad MH. Information transfer at hospital discharge: a systematic review. J Patient Saf. 2016. https://doi.org/10.1097/PTS.0000000000000248.

    Article  PubMed  Google Scholar 

  21. Abramson EL, Pfoh ER, Barrón Y, Quaresimo J, Kaushal R. The effects of electronic prescribing by community-based providers on ambulatory medication safety. Jt Comm J Qual Patient Saf. 2013;39(12):545–52.

    Article  Google Scholar 

  22. Mehrmann L, Ollenschläger G. Problemfelder und Best-Practice-Ansätze in der Arzneimittelversorgung an intersektoralen Schnittstellen—Eine Literaturanalyse. Z Evid Fortbild Qual Gesundhwes. 2014;108(1):66–77.

    Article  Google Scholar 

  23. Dilks S, Emblin K, Nash I, Jefferies S. Pharmacy at home: service for frail older patients demonstrates medicines risk reduction and admission avoidance. Clin Pharm. 2016 [cited 2017 Jan 1];8(7). http://www.pharmaceutical-journal.com/research/research-article/pharmacy-at-home-service-for-frail-older-patients-demonstrates-medicines-risk-reduction-and-admission-avoidance/20201303.article.

  24. Viktil KK, Blix HS. The impact of clinical pharmacists on drug-related problems and clinical outcomes. Basic Clin Pharmacol Toxicol. 2008;102(3):275–80.

    CAS  Article  Google Scholar 

  25. Reidt S, Holtan H, Stender J, Salvatore T, Thompson B. Integrating home-based medication therapy management (MTM) services in a health system. J Am Pharm Assoc. 2016;56(2):178–83.

    Article  Google Scholar 

  26. Vrbnjak D, Denieffe S, O’Gorman C, Pajnkihar M. Barriers to reporting medication errors and near misses among nurses: a Systematic review. Int J Nurs Stud. 2016;63:162–78.

    Article  Google Scholar 

Download references

Acknowledgements

The authors would like to thank the team of Spitex Stadt Luzern, specifically Tamara Renner, director, for enabling this study. We would also like to acknowledge Prof. Kurt Hersberger and Dr. Fabienne Böni, Pharmaceutical Care Research Group, University of Basel, Basel, Switzerland for their guidance compiling the documents for approval by the Ethics Committee.

Funding

Part of this work was funded by the non-for-profit Home Care Organization Spitex Stadt Luzern/Switzerland, the Spitex Association of the Canton of Lucerne/Switzerland, the Department of Health of the Canton of Lucerne/Switzerland, and the LOA IV foundation of the Swiss Society of Pharmacists and the Swiss health insurance companies.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Carla Meyer-Massetti.

Ethics declarations

Conflicts of interest

The authors declare that they have no conflicts of interest.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Meyer-Massetti, C., Hofstetter, V., Hedinger-Grogg, B. et al. Medication-related problems during transfer from hospital to home care: baseline data from Switzerland. Int J Clin Pharm 40, 1614–1620 (2018). https://doi.org/10.1007/s11096-018-0728-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11096-018-0728-3

Keywords

  • Home care
  • Hospital discharge
  • Medication safety
  • Seamless care
  • Switzerland
  • Transition of care