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Medication Lapses Put Discharged Patients at Risk

Cheryl Clark, for HealthLeaders Media, August 25, 2011

When patients are hospitalized, they are at much greater risk for having their chronic condition medications unintentionally discontinued rather than restored at discharge, which increases the chance they'll be back in an emergency room, be emergently readmitted, or die.

The lapse in restoring needed prescription medications as the patient leaves the hospital is especially problematic in patients that have been cared for in an intensive care unit.

Those are findings from a Canadian study of nearly 400,000 patients 66 years of age and older who were cared for in Ontario hospitals between 1997 and 2009. The patients had shown stability and compliance because they had been on the medications for at least one year before the study. But after discharge, the report found, as many as 22.8% who should have been on anti-platelet drugs failed to renew prescriptions within 90 days.

The report is published in Thursday's Journal of the American Medical Association.

"Gaps in the continuity of care are an area of vulnerability for patient safety," said the authors, led by Chaim Bell, MD, of St. Michael's Hospital and the Institute for Clinical Evaluative Sciences in Toronto, and colleagues. "We found that patients discharged from the hospital have an elevated risk of not continuing their long-term medications for chronic diseases and that treatment in the ICU appears to further increase this risk."

The study calls for hospital teams to pay increased attention to transitions in care so that medications temporarily and reasonably discontinued during hospitalization are restored when the patient returns home.

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