title: Medication safety at the interface: evaluating risks associated with discharge prescriptions from mental health hospitals.
abstract: OBJECTIVE
  When compared to general hospitals, relatively little is known about the quality and safety of discharge prescriptions from specialist mental health settings. We aimed to investigate the quality and safety of discharge prescriptions written at mental health hospitals.
  
  
  METHODS
  This study was undertaken on acute adult and later life inpatient units at three National Health Service (NHS) mental health trusts. Trained pharmacy teams prospectively reviewed all newly written discharge prescriptions over a 6-week period, recording the number of prescribing errors, clerical errors and errors involving lack of communication about medicines stopped during hospital admission. All prescribing errors were reviewed and validated by a multidisciplinary panel. Main outcome measures were the prevalence (95% CI) of prescribing errors, clerical errors and errors involving a lack of details about medicines stopped. Risk factors for prescribing and clerical errors were examined via logistic regression and results presented as odds ratios (OR) with corresponding 95% CI.
  
  
  CONCLUSIONS
  Of 274 discharge prescriptions, 259 contained a total of 1456 individually prescribed items. One in five [20·8% (95%CI 15·9-25·8%)] eligible discharge prescriptions and one in twenty [5·1% (95%CI 4·0-6·2%)] prescribed or omitted items were affected by at least one prescribing error. One or more clerical errors were found in 71·9% (95%CI 66·5-77·3%) of discharge prescriptions, and more than two-thirds [68·8% (95%CI 56·6-78·8%)] of eligible discharge prescriptions erroneously lacked information on medicines discontinued during hospital admission. Logistic regression analyses revealed that middle-grade [whole discharge prescription level OR 3·28 (3·03-3·56)] and senior [whole discharge OR 1·43 (1·04-1·96)] prescribers as well as electronic discharge prescription pro formas [whole discharge OR 2·43 (2·08-2·83)] were all associated with significantly higher risks of prescribing errors than junior prescribers and handwritten discharges, respectively. Similar findings were reported at the individually prescribed item level. Middle-grade prescribers were also more likely to make both non-psychotropic and psychotropic prescribing errors than their junior colleagues [individual item OR 4·24 (2·14-8·40) and OR 1·70 (1·16-2·48), respectively].
  
  
  CONCLUSIONS
  Discharge prescriptions issued by mental health NHS hospitals are affected by high levels of prescribing, clerical and communication errors. Important targets for intervention have been identified to improve medication safety problems at care transfer.
authors.affiliation: Centre for Pharmacoepidemiology and Drug Safety, Manchester Pharmacy School, Manchester Academic Health Sciences Centre (MAHSC), University of Manchester, Manchester, UK.|NIHR Greater Manchester Primary Care Patient Safety Translational Research Centre, MAHSC, University of Manchester, Manchester, UK.
authors.forename: R N
authors.initials: RN
authors.lastname: Keers
authors.affiliation: Centre for Pharmacoepidemiology and Drug Safety, Manchester Pharmacy School, Manchester Academic Health Sciences Centre (MAHSC), University of Manchester, Manchester, UK.|Pharmacy Department, University Hospital of South Manchester NHS Foundation Trust, MAHSC, Manchester, UK.
authors.forename: S D
authors.initials: SD
authors.lastname: Williams
authors.affiliation: Adult Services Warrington, 5 Boroughs Partnership NHS Foundation Trust, Warrington, Cheshire, UK.|Medical School, University of Liverpool, Liverpool, UK.
authors.forename: J J
authors.initials: JJ
authors.lastname: Vattakatuchery
authors.affiliation: Pharmacy Department, Manchester Mental Health and Social Care Trust, MAHSC, Manchester, UK.
authors.forename: P
authors.initials: P
authors.lastname: Brown
authors.affiliation: Pharmacy Department, Greater Manchester West Mental Health NHS Foundation Trust, Salford, UK.
authors.forename: J
authors.initials: J
authors.lastname: Miller
authors.affiliation: Medicines Management Team, 5 Boroughs Partnership NHS Foundation Trust, Warrington, Cheshire, UK.
authors.forename: L
authors.initials: L
authors.lastname: Prescott
authors.affiliation: Centre for Pharmacoepidemiology and Drug Safety, Manchester Pharmacy School, Manchester Academic Health Sciences Centre (MAHSC), University of Manchester, Manchester, UK.|NIHR Greater Manchester Primary Care Patient Safety Translational Research Centre, MAHSC, University of Manchester, Manchester, UK.
authors.forename: D M
authors.initials: DM
authors.lastname: Ashcroft
mesh_terms: D000328:Adult; D000368:Aged; D011307:Drug Prescriptions / Q000592:standards*; D055695:Electronic Prescribing / Q000592:standards; D006760:Hospitalization; D006801:Humans; D057970:Inappropriate Prescribing / Q000009:adverse effects*; D008603:Mental Health; D010351:Patient Discharge; D055553:Prescription Drugs / Q000009:adverse effects*; D011619:Psychotropic Drugs / Q000009:adverse effects*; D018570:Risk Assessment; D012307:Risk Factors; D012449:Safety
chemical_list: D055553:Prescription Drugs; D011619:Psychotropic Drugs
keywords: care transfer; discharge; medication errors; mental health; psychiatry