Skip to main content
SpringerLink
Log in

Discontinuity of chronic medications in patients discharged from the intensive care unit

  • Original Articles
  • Published:
Journal of General Internal Medicine Aims and scope Submit manuscript

Abstract

BACKGROUND: Intensive care unit (ICU) admission may connote an elevated risk of unintentional chronic medication discontinuation because of its focus on acute illnesses and the multiple care transitions.

OBJECTIVE: To determine the proportion of patients discharged from the ICU whose previously prescribed chronic medications were unintentionally discontinued during their hospitalization.

DESIGN AND PARTICIPANTS: Hospital records of consecutive ICU discharges at 1 academic and 2 community hospitals in Toronto. Canada, throughout 2002 were reviewed. Eligible patients were prescribed at least 1 of 6 medication groups before hospitalization: (1) HMG co-A reductase inhibitors (statins); (2) antiplatelets/ anticoagulants (aspirin, clopidogrel, ticlopidine, warfarin); (3)l-thyroxine; (4) non-prn inhalers (anticholinergic, β-agonist, or steroid); (5) acid-suppressing drugs (H2 antagonists and proton pump inhibitors); and (6) allopurinol.

MEASUREMENTS: Use of explicit criteria to assess the proportion of patients whose previously prescribed chronic medications were unintentionally discontinued at hospital discharge.

RESULTS: A total of 1,402 charts were eligible for the study and 834 had prescriptions for at least 1 of the medication groups. Thirty-three percent (251/834) of patients had 1 or more of their chronic medications omitted at hospital discharge. Multivariable logistic regression analysis found that patients from the academic hospital (adjusted odds ratio [OR]=0.70, 95% confidence interval [CI] 0.49 to 1.0) and those with medical diagnoses (adjusted OR=0.48, 95% CI 0.31 to 0.75) had a decreased risk for chronic medication discontinuation.

CONCLUSIONS: Patients discharged from the ICU often leave the hospital without note of their previously prescribed chronic medications. Careful review of medication lists at ICU discharge could avoid potential adverse outcomes related to unintentional discontinuation of chronic medications at hospital discharge.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Haynes RB, Taylor DW, Sackett DL. Compliance in Health Care. Baltimore, MD: Johns Hopkins Press; 1979.

    Google Scholar 

  2. McDonald HP, Garg AX, Haynes RB. Interventions to enhance patient adherence to medication prescriptions: scientific review. JAMA. 2002;288:2868–79.

    Article  PubMed  Google Scholar 

  3. Haynes RB, McDonald HP, Garg AX. Helping patients follow prescribed treatment: clinical applications. JAMA. 2002;288:2880–3.

    Article  PubMed  Google Scholar 

  4. Cook RI, Render M, Woods DD. Gaps in the continuity of care and progress on patient safety. BMJ. 2000;320:791–4.

    Article  PubMed  CAS  Google Scholar 

  5. Coleman EA, Berenson RA. Lost in transition: challenges and opportunities for improving the quality of transitional care. Ann Intern Med. 2004;141:533–6.

    PubMed  Google Scholar 

  6. Lofgren RP, Gottlieb D, Williams RA, Rich EC. Post-call transfer of resident responsibility: its effect on patient care. J Gen Intern Med. 1990;5:501–5.

    Article  PubMed  CAS  Google Scholar 

  7. Gottlieb DJ, Parenti CM, Peterson CA, Lofgren RP. Effect of a change in house staff work schedule on resource utilization and patient care. Arch Intern Med. 1991;151:2065–70.

    Article  PubMed  CAS  Google Scholar 

  8. Petersen LA, Brennan TA, O’Neil AC, Cook EF, Lee TH. Does housestaff discontinuity of care increase the risk for preventable adverse events? Ann Intern Med. 1994;121:866–72.

    PubMed  CAS  Google Scholar 

  9. Pronovost P, Weast B, Schwarz M, et al. Medication reconciliation: a practical tool to reduce the risk of medication errors. J Crit Care. 2003;18:201–5.

    Article  PubMed  Google Scholar 

  10. Moore C, Wisnivesky J, Williams S, McGinn T. Medical errors related to discontinuity of care from an inpatient to an outpatient setting. J Gen Intern Med. 2003;18:646–51.

    Article  PubMed  Google Scholar 

  11. Heeschen C, Hamm CW, Laufs U, Snapinn S, Bohm M, White HD. Withdrawal of statins increases event rates in patients with acute coronary syndromes. Circulation. 2002;105:1446–52.

    Article  PubMed  CAS  Google Scholar 

  12. Graves T, Hanlon JT, Schmader KE, et al. Adverse events after discontinuing medications in elderly outpatients. Arch Intern Med. 1997;157:2205–10.

    Article  PubMed  CAS  Google Scholar 

  13. Boockvar K, Fishman E, Kyriacou CK, Monias A, Gavi S, Cortes T. Adverse events due to discontinuations in drug use and dose changes in patients transferred between acute and long-term care facilities. Arch Intern Med. 2004;164:545–50.

    Article  PubMed  Google Scholar 

  14. Fodor JG, Frohlich JJ, Genest JJ, McPherson PR. Recommendations for the management and treatment of dyslipidemia. Report of the working group on hypercholesterolemia and other dyslipidemias. Can Med Assoc J. 2000;162:1441–7.

    CAS  Google Scholar 

  15. Green CJ, Hadorn DC, Bassett K, Kazanjian A. Anticoagulation in chronic nonvalvular atrial fibrillation: a critical appraisal and meta-analysis. Can J Cardiol. 1997;13:811–5.

    PubMed  CAS  Google Scholar 

  16. Harrington RA, Becker RC, Ezekowitz M, et al. Antithrombotic therapy for coronary artery disease: the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy. Chest. 2004;126(3 Suppl):513S-48S.

    Article  PubMed  CAS  Google Scholar 

  17. Singer PA, Cooper DS, Levy EG, et al. Treatment guidelines for patients with hyperthyroidism and hypothyroidism. Standards of care committee, American Thyroid Association. JAMA. 1995;273:808–12.

    Article  PubMed  CAS  Google Scholar 

  18. O’Donnell DE, Aaron S, Bourbeau J, et al. Canadian Thoracic Society recommendations for management of chronic obstructive pulmonary disease—2003. Can Respir J. 2003;10(Suppl A):11A-65A.

    PubMed  Google Scholar 

  19. DeVault KR, Castell DO. Updated guidelines for the diagnosis and treatment of gastroesophageal reflux disease. Am J Gastroenterol. 2005;100:190–200.

    Article  PubMed  Google Scholar 

  20. Terkeltaub RA. Clinical practice. Gout. N Engl J Med. 2003;349:1647–55.

    Article  CAS  Google Scholar 

  21. Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics. 1977;33:159–74.

    Article  PubMed  CAS  Google Scholar 

  22. Kohn LT, Corrigan JM, Donaldson MS, eds. To Err is Human: Building a Safer Health System. Washington, DC: National Academy of Sciences; 2000.

    Google Scholar 

  23. Weingart SN, Wilson RM, Gibberd RW, Harrison B. Epidemiology of medical error. BMJ. 2000;320:774–7.

    Article  PubMed  CAS  Google Scholar 

  24. Coleman EA, Smith JD, Raha D, Min SJ. Posthospital medication discrepancies: prevalence and contributing factors. Arch Intern Med. 2005;165:1842–7.

    Article  PubMed  Google Scholar 

  25. Gandhi TK. Fumbled handoffs: one dropped ball after another. Ann Intern Med. 2005;142:352–8.

    PubMed  Google Scholar 

  26. Forster AJ, Murff HJ, Peterson JF, Gandhi TK, Bates DW. The incidence and severity of adverse events affecting patients after discharge from the hospital. Ann Intern Med. 2003;138:161–7.

    PubMed  Google Scholar 

  27. Bajcar J, Farrell B, Foisy M. Patient-centered transfer of medication related information. Can Pharm J. 1997;130:27–30.

    Google Scholar 

  28. Cornish PL, Knowles SR, Marchesano R, et al. Unintended medication discrepancies at the time of hospital admission. Arch Intern Med. 2005;165:424–9.

    Article  PubMed  Google Scholar 

  29. Coleman EA, Mahoney E, Parry C. Assessing the quality of preparation for posthospital care from the patient’s perspective: the care transitions measure. Med Care. 2005;43:246–55.

    Article  PubMed  Google Scholar 

  30. Institute for Health Improvement. Getting Started Kit: Prevent Adverse Drug Events (Medication Reconciliation). Institute for Health Improvement. 2005. Available at: http://www.ihi.org/NR/rdonlyres/47D5AE1C0B29-4A59-8D58-BABF8F4E829F/0/ADEHowtoGuideFINAL5_25.pdf. Accessed January 23, 2006.

  31. Kaushal R, Barker KN, Bates DW. How can information technology improve patient safety and reduce medication errors in children’s health care? Arch Pediatr Adolesc Med. 2001;155:1002–7.

    PubMed  CAS  Google Scholar 

  32. Kellaway GS, McCrae E. Non-compliance and errors of drug administration in patients discharged from acute medical wards. N Z Med J. 1975;81:508–12.

    PubMed  CAS  Google Scholar 

  33. Schumock GT, Guenette AJ, Keys TV, Hutchinson RA. Prescribing errors for patients about to be discharged from a university teaching hospital. Am J Hosp Pharm. 1994;51:2288–90.

    PubMed  CAS  Google Scholar 

  34. Abrams J, Andrews K. The influence of hospital admission on long-term medication of elderly patients. J Roy Coll Physicians London. 1984;18:225–7.

    CAS  Google Scholar 

  35. Beers MH, Dang J, Hasegawa J, Tamai IY. Influence of hospitalization on drug therapy in the elderly. J Am Geriatr Soc. 1989;37:679–83.

    PubMed  CAS  Google Scholar 

  36. Brook RH, Appel FA, Avery C, Orman M, Stevenson RL. Effectiveness of inpatient follow-up care. N Engl J Med. 1971;285:1509–14.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Foculty of Medicine, University of Toronto, Toronto, ON, Canada

    Chaim M. Bell MD, PhD, FRCP(C), Parisa Rahimi-Darabad MD & Avi I. Orner MD

  2. Department of Medicine, University of Toronto, Toronto, ON, Canada

    Chaim M. Bell MD, PhD, FRCP(C) & Parisa Rahimi-Darabad MD

  3. Department of Health Policy Management and Evaluation, University of Toronto, Toronto, ON, Canada

    Chaim M. Bell MD, PhD, FRCP(C)

  4. The Institute for Clinical Evaluative Sciences, University of Toronto, Toronto, ON, Canada

    Chaim M. Bell MD, PhD, FRCP(C)

  5. Department of Medicine, St. Michael’s Hospital, Toronto, ON, Canada

    Chaim M. Bell MD, PhD, FRCP(C)

Authors
  1. Chaim M. Bell MD, PhD, FRCP(C)
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Parisa Rahimi-Darabad MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Avi I. Orner MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Chaim M. Bell MD, PhD, FRCP(C).

Additional information

None of the authors have any conflicts of interest to declare.

Dr. Bell is the recipient of a Phase 2 Clinician-Scientist Award from the Canadian Institutes of Health Research. The funding agencies had no role in the design and conduct of the study; collection, management, analysis, or interpretation of the data; or preparation, review, or approval of the manuscript. The correxponding author had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Bell, C.M., Rahimi-Darabad, P. & Orner, A.I. Discontinuity of chronic medications in patients discharged from the intensive care unit. J GEN INTERN MED 21, 937–941 (2006). https://doi.org/10.1007/BF02743141

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF02743141

Key Words

Search

Navigation