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Medication errors may be common after hospital discharge

By Krystnell Storr

NEW YORK (Reuters Health) - More than half of heart patients in a new U.S. study made mistakes taking their medications or misunderstood instructions given to them after being discharged from the hospital.

Those with the lowest “health literacy” were among the most likely to make the risky errors, highlighting the importance of healthcare professionals making sure their instructions are clear and of patients being sure they understand what they need to do after they get home, the study authors say.

“Some errors have the potential to be harmful to patients,” said lead author Dr. Amanda Mixon, a hospitalist with the VA Tennessee Valley Healthcare System in Nashville.

“Thousands of patients are discharged home with medications every day. Knowing which patients are at risk of medication errors after patients go home can help inpatient providers counsel patients about their medications before they go home,” added Mixon, who is also affiliated with Vanderbilt University.

Past research suggests that an individual’s health literacy, the ability to interpret and act on health information, is a strong predictor of whether they will correctly follow instructions for their own care (see Reuters Health article of October 25, 2013, here: http://reut.rs/UdH55N).

Overall, 20 to 30 percent of prescriptions are never filled, and 50 percent are not continued as prescribed, according to the U.S. Centers for Disease Control and Prevention.

To assess what factors might influence whether heart patients will follow their care instructions correctly after leaving the hospital, Mixon’s team recruited 471 people hospitalized for heart failure, heart attacks and related conditions, then discharged from the hospital.

The participants’ average age was 59 and just under half were women. Every participant took a seven-minute health literacy test to gauge their understanding of health information as well as a short numeracy test to measure basic math skills.

The researchers contacted the patients by telephone two to three days after they left the hospital and compared the medications on the discharge list from their doctors to what the patients said they were taking.

When someone said they were taking a medication not on the list, or forgot to mention one that was on the list, it was counted as an error. If a patient didn’t know the purpose, dose or frequency of a medication, it was classified as a misunderstanding.

Failure to refill a prescription, discontinuing use of a medication against a healthcare professional’s orders or not being aware of a medication were also counted as errors.

More than half - 242 of the 471 patients - had at least one discrepancy between the medications they reported taking, and the ones on their discharge list. Over a quarter left out one or more medications on their list and more than a third were taking something that wasn’t on the list. And 59 percent of patients had a misunderstanding of the purpose, dose or frequency of their medications.

Participants who scored highest on the math skills test were about 23 percent less likely than those who scored lowest to add or omit medications, the researchers report in Mayo Clinic Proceedings.

People with the highest health literacy scores were about 16 percent less likely to make an error compared to those who scored lowest. And women were about 40 percent less likely than men to make a mistake.

Single people were almost 70 percent more likely than people who were married to make errors. Older age and worse cognitive function also predicted higher odds of having an error.

"It’s a powerful study in that it helps to define some of the things we assume, but haven't been able to fully understand," said Dr. Benjamin Brooke, a surgeon and professor at the University of Utah School of Medicine in Salt Lake City, who was not involved in the study.

“I think this says that we need to do a better job of understanding a patient at the time of discharge, what are their risks of having a post discharge adverse event,” he told Reuters Health.

In healthcare, "there’s a lot of moving parts and it’s difficult to make sure they all move in tandem,” he noted. “A patient may see a doctor for 20 years and then end up seeing another one who does not know their medical history as well. But this is a global issue. There’s a lot of errors that occur when we leave the hospital."

He favors the idea of a brief health literacy test that might identify patients most likely to have trouble following treatment instructions after discharge. “Whether it's a quick streamlined tool that nurses or anyone part of the medical team can administer, it’s something that might be feasible," he said.

"The main thing is, we need to be aware of the problem and the study points out some of the things we need to focus on more closely," he said.

Mixon said that for patients who have low health literacy or numeracy, healthcare providers need to be especially careful in counseling them about their medications at hospital discharge.

She added that patients can also be proactive and assertive by asking a healthcare professional to carefully review the medications they are required to take at home, making sure to ask questions about previously prescribed medications and whether or not they should be continued.

SOURCE: http://bit.ly/1jQCCm1 Mayo Clinic Proceedings, online July 03, 2014.

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