Avantika Saraf Shah1, Emily Kay Hollingsworth1, Matthew Stephen Shotwell2, Amanda S Mixon1,3,4, Sandra Faye Simmons1,5,3, Eduard Eric Vasilevskis1,3,4. 1. Center for Quality Aging, Vanderbilt University Medical Center, Nashville, Tennessee, USA. 2. Department of Biostatistics, Vanderbilt University, Nashville, Tennessee, USA. 3. VA Tennessee Valley Healthcare System, Geriatric Research Education and Clinical Center, Nashville, Tennessee, USA. 4. Section of Hospital Medicine, Division of General Internal Medicine & Public Health, Vanderbilt University Medical Center, Nashville, Tennessee, USA. 5. Division of Geriatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
Abstract
BACKGROUND: Hospitalized older adults have a high prevalence of polypharmacy and medication inaccuracies. Gathering the best possible medication history (BPMH) is necessary to accurately identify each medication for multimorbid older adults. The objective was to describe a multipronged approach to obtaining the BPMH for hospitalized older adults, quantify the medication discrepancies identified through these sources, and explore factors associated with these discrepancies. METHODS: Cross-sectional analysis of 372 hospitalized older adults (age ≥ 50) transitioning to post-acute care as part of a randomized controlled trial to reduce medication burden. We used four information sources to yield a BPMH. Medication discrepancies at hospital admission were categorized as omissions, additions, and dose discrepancies after comparing alternate sources with the electronic medical record (EMR). Multivariate regression analysis, including patient factors (e.g., age, prehospital medication count, number of pharmacies), was performed to identify factors associated with the total count of medication discrepancies. RESULTS: Ninety percent of participants had at least one medication discrepancy and 46% used more than one pharmacy. The majority of discrepancies were omissions. Among the entire cohort, there was a median of two omitted medications per patient across two alternate sources-pharmacy refill history and bedside interview. Lower age, greater total number of prehospital medications, and admission from assisted living or skilled nursing facility were significantly associated with greater medication discrepancies. CONCLUSION: A multipronged and consistent approach to obtain a BPMH during hospitalization for multimorbid older adults revealed medication discrepancies that should be addressed prior to hospital discharge to support safe prescribing practices.
BACKGROUND: Hospitalized older adults have a high prevalence of polypharmacy and medication inaccuracies. Gathering the best possible medication history (BPMH) is necessary to accurately identify each medication for multimorbid older adults. The objective was to describe a multipronged approach to obtaining the BPMH for hospitalized older adults, quantify the medication discrepancies identified through these sources, and explore factors associated with these discrepancies. METHODS: Cross-sectional analysis of 372 hospitalized older adults (age ≥ 50) transitioning to post-acute care as part of a randomized controlled trial to reduce medication burden. We used four information sources to yield a BPMH. Medication discrepancies at hospital admission were categorized as omissions, additions, and dose discrepancies after comparing alternate sources with the electronic medical record (EMR). Multivariate regression analysis, including patient factors (e.g., age, prehospital medication count, number of pharmacies), was performed to identify factors associated with the total count of medication discrepancies. RESULTS: Ninety percent of participants had at least one medication discrepancy and 46% used more than one pharmacy. The majority of discrepancies were omissions. Among the entire cohort, there was a median of two omitted medications per patient across two alternate sources-pharmacy refill history and bedside interview. Lower age, greater total number of prehospital medications, and admission from assisted living or skilled nursing facility were significantly associated with greater medication discrepancies. CONCLUSION: A multipronged and consistent approach to obtain a BPMH during hospitalization for multimorbid older adults revealed medication discrepancies that should be addressed prior to hospital discharge to support safe prescribing practices.
Authors: Vincent C Tam; Sandra R Knowles; Patricia L Cornish; Nowell Fine; Romina Marchesano; Edward E Etchells Journal: CMAJ Date: 2005-08-30 Impact factor: 8.262
Authors: Nadine Shehab; Maribeth C Lovegrove; Andrew I Geller; Kathleen O Rose; Nina J Weidle; Daniel S Budnitz Journal: JAMA Date: 2016-11-22 Impact factor: 56.272
Authors: Eduard E Vasilevskis; Avantika S Shah; Emily K Hollingsworth; Matthew S Shotwell; Amanda S Mixon; Susan P Bell; Sunil Kripalani; John F Schnelle; Sandra F Simmons Journal: BMC Health Serv Res Date: 2019-03-14 Impact factor: 2.655