Doctors fail to predict discharged patients at risk of medication harm

A study published in the British Journal of Clinical Pharmacology has shown that doctors are poor at predicting medication-related harm, but suggested that pharmacist input could help minimise risks.

Ambulances at A&E

Doctors are poor at predicting which patients may be at risk for medication-related harm after their discharge from hospital, a study has found.

Writing in the British Journal of Clinical Pharmacology
[1]
, the researchers pointed out that there are currently no risk prediction tools to identify those patients most likely to suffer medicines-related harm after discharge.

They found that doctors with the greatest clinical experience could not reliably judge which patients were most at risk of needing extra treatment in the eight weeks after they were sent home, owing to problems with medication relating to polypharmacy or other medication-related problems. However, the researchers suggested that pharmacist input on discharge decisions could lead to better identification of at-risk patients.

The study of more than 1,000 patients across 5 teaching hospitals found that 30% required treatment for medication-related harm in the 2 months after discharge, either through A&E or hospital admission, outpatient consultation, or a GP visit.

Most of the doctors dealing with discharge were junior doctors, but seniority did not make a difference to risk prediction in the patients, who had a median age of 82 years and were discharged with an average of 9 medicines.

One explanation for the findings, the researchers concluded, was poor knowledge of clinical pharmacology among junior doctors. They advised that risk prediction might be more successful if it was a team effort. 

“Combining the doctors’ clinical knowledge with pharmacist expertise on medication safety and management, including drug interactions, contraindications, adherence and monitoring, and insight from nurses on the patient’s environment, could lead to more accurate identification of high-risk patients,” they wrote.

References

[1] Parekh N, Stevenson J, Schiff R et al. Can doctors identify older patients at risk of medication harm following hospital discharge? A multicentre prospective study in the UK. Br J Clin Pharmacol 2018. doi: 10.1111/bcp.13690

Last updated
Citation
The Pharmaceutical Journal, July 2018;Online:DOI:10.1211/PJ.2018.20205104