Adverse events due to discontinuations in drug use and dose changes in patients transferred between acute and long-term care facilities.
BACKGROUND
Care transitions are commonplace for ill older adults, but no studies to our knowledge have examined the occurrence of iatrogenic harm from medication changes during patient transfer.


OBJECTIVE
To identify medication changes during transfer between hospital and nursing home and adverse drug events (ADEs) caused by these changes.


METHODS
Participants were residents of 4 nursing homes in the New York City metropolitan area admitted to 2 academic hospitals. Nursing home and hospital medical records were reviewed to identify changes in medication regimens between sites. Medications were matched and compared regarding dosage, route, and frequency of administration. Two physician investigators used structured implicit review to identify ADEs attributable to transfer-related medication changes.


RESULTS
During a total of 122 admissions, the mean numbers of medications altered during transfer from nursing home to hospital and hospital to nursing home were 3.1 and 1.4, respectively (P<.001 for comparison). Most changes in drug use were discontinuations, followed by dose changes and class substitutions. Of 71 bidirectional transfers that were reviewed by 2 physician investigators, ADEs attributable to medication changes occurred during 14 (20%). The overall risk of ADE per drug alteration (n = 320) was 4.4% (95% confidence interval, 2.5%-7.4%). Although most medication changes (8/14) implicated in causing ADEs occurred in the hospital, most ADEs (12/14) occurred in the nursing home after nursing home readmission.


CONCLUSIONS
Medication changes are common during transfer between hospital and nursing home and are a cause of ADEs. Research is needed on interinstitutional patient care and systems interventions designed to prevent ADEs.
Brookdale Department of Geriatrics and Adult Development, Mount Sinai School of Medicine, New York, NY 10029, USA. kenneth.boockvar@mssm.edu
Kenneth
K
Boockvar
Eliot
E
Fishman
Corinne Kay
CK
Kyriacou
Anna
A
Monias
Shai
S
Gavi
Tara
T
Cortes
D016907:Adverse Drug Reaction Reporting Systems; D000368:Aged; D003266:Continuity of Patient Care; D004358:Drug Therapy / Q000592:standards; D017723:Drug Utilization Review; D064420:Drug-Related Side Effects and Adverse Reactions; D005260:Female; D006801:Humans; D007049:Iatrogenic Disease / Q000453:epidemiology; D016014:Linear Models; D008297:Male; D008508:Medication Errors; D008510:Medication Systems, Hospital / Q000592:standards* / Q000706:statistics & numerical data; D009519:New York City / Q000453:epidemiology; D009735:Nursing Homes / Q000592:standards* / Q000706:statistics & numerical data; D010360:Patient Transfer; D019338:Polypharmacy